As health care reform is being hotly debated around the country, a “public option” is frequently mentioned. It made me start thinking about the public options for health care that already exist.
The major example of public health care is Medicare that covers everyone over 65, is almost always utilized and is extremely popular.
In fact, one of the funniest quotes I’ve read in a newspaper account of a town hall meeting was from a man who stood up to yell “Just keep your government hands off my Medicare!”
Our military families and our veterans have government-provided health care. Medicaid is another public option that pays for nursing home care for those who cannot afford it, for care of disabled persons, and for low-income children.
The most recent entrant to public options for health care is the Children’s Health Insurance Program or CHIP. First authorized in 1997, it has become the nation’s primary source of coverage for uninsured children of modest income families who are not poor enough to qualify for Medicaid.
Together with Medicaid, CHIP provides a safety net for low-income children and has reduced the number of uninsured children. In 2008, 7.4 million children received health coverage through CHIP; however, gaps in coverage remained with more than 9 million uninsured children nationally.
Earlier this year Congress reauthorized the program, increasing funding to maintain coverage for the 7.4 million children and to enroll another 4.1 million children nationwide. A 62 cent increase in the federal cigarette tax will fund the expanded program. It also allows states to cover low-income pregnant women under certain conditions.
States participate financially in CHIP, providing one dollar for every two dollars of federal funding, a match rate that is attractive to states. The program began slowly in Virginia. Under Governor Gilmore participation rates were quite low; Virginia did not receive its full allocation of federal dollars; and many eligible children were not covered.
After Governor Mark Warner was elected, that all changed. His administration made a major effort to enroll children in the program and before long 98% of eligible children were enrolled. The work on CHIP also found more children who were eligible for Medicaid so coverage improved in that program as well.
In Virginia as in other states, CHIP has been wildly successful: Children get their immunizations and have well-child visits to the doctor; problems can be detected early and treated long before children start school; chronic diseases like asthma are better controlled, resulting in fewer hospitalizations.
Some states are so pleased with the program that it is being expanded with state funding and premiums to provide universal coverage. In Illinois, for example, the AllKids program, which began in July 2006, provides comprehensive health insurance to uninsured residents up to age 18. Premiums are based on a sliding scale related to the parents’ income so they can get coverage for their children even if their employer does not provide health insurance. It’s a great public option.
