In 1997, there was a great push in Congress to pass a balanced budget bill. While understanding the need for the nation to be fiscally responsible, advocates for children warned that the budget should not be balanced on the back of the nation's 11 million children who were without health insurance. Advocates felt some success when the Balanced Budget Act of 1997 was adopted and signed into law which included the Children's Health Insurance Program (CHIP). It targets uninsured children under 19 with family incomes below 200% of poverty who are not currently eligible for Medicaid or covered by private inurance.

CHIP reflected a bipartisan agreement that our children should have accessible and affordable health coverage. Although this may also be the desire of children's parents, there is a gap between the desire and reality. According to a November 1999 Kaiser Commission report on "Health Coverage for Low-Income Children, "two-thirds of these children (8 million) lived in families with household incomes below 200% of poverty. Eight out of ten (79%) low-income children have parents who work full-or part-time. Some of the parents work for employers who offer health insurance but the parent cannot afford the premiums or deductibles or co-payments.

Many more children are eligible for Medicaid but are not enrolled. Enrolling uninsured children eligible for Medicaid as well as CHIP is critical. Three years after CHIP's creation there are still challenges to overcome. An estimated 4.7 million uninsured children are potentially already eligible for Medicaid and an additional 2.6 million are now eligible under CHIP plans. States can extend coverage to even more uninsured children than in their current plans and still receive federal matching funds.

States and the federal governments have made considerable progress in implementing the State Children's Health Insurance Program (SCHIP), according to the U.S. General Accounting Office, Children's Health Insurance Program, May 1999. Even though states have been expanding Medicaid eligibility levels for the past decade, Title XXI of the Balanced Budget Act of 1997 authorizes them to increase eligibility levels further for infants and children under SCHIP. SCHIP provides states with approximately $4.8 billion annually to provide or purchase health insurance for uninsured children. The Congressional Budget Office estimates that under SCHIP, 2.8 million uninsured children who are not eligible for Medicaid will be covered; another 660,000 uninsured children will be enrolled in Medicaid as a result of SCHIP outreach efforts.

States have three options for implementing SCHIP. They may (1) design and develop a separate state insurance, (2) expand their current Medicaid program, or (3) combine the two approaches. While eligibility criteria vary by state, most children in working families of four earning up to $33,400 a year would qualify. Eligibility levels for state programs, however, are subject to change. For the most accurate information about your state program, call 1-877-KIDS-NOW (1-877-543-7669). You can also get information on the internet by visiting the Children's Defense Fund's web site at www.childrensdefense.org/signup. It contains more detailed information on each state's eligibility criteria, benefits, and application process; a flyer for each state's new program; and contact names and telephone numbers for more information on each state's CHIP and Medicaid outreach efforts.

Another issue that affects children that is currently gaining more attention is the health of their parents. Even when the child is insured, what happens when an uninsured parent who is the primary caregiver is uninsured and becomes sick? Generally this will affect the well-being of the child. Stating that coverage for parents enables better health care for children, The Medicaid and CHIP Family Care Improvement Act of 2000 (S 2923) was introduced in the Senate on July 26. Companion legislation (HR 4927) was introduced two days earlier in the House. Key sponsors included Senators Edward M. Kennedy (D-Mass.) and John D. Rockefeller IV (D-W.Va.) and Representatives John D. Dingle (D-Mich.), Henry Waxman (D-Calif.), Sherrod Brown (D-ohio) and Gene Green (D-Texas).

Kennedy said the bill is intended to provide states with the resources, incentives and authority to extend Medicaid and CHIP to the parents of children covered under those programs. He said the bill includes provisions to improve outreach and enrollment for SCHIP and Medicaid. Specifically, the bill would make available $50 billion in new federal money for states to provide health insurance coverage to parents of children enrolled in SCHIP and Medicaid. Funding would be allotted to states under the same formula as under SCHIP. Sen. Kennedy hopes to move the bill sometime in September by attaching it to a tax bill or omnibus appropriations bill.

Although there may not be any legislative action in the remaining few days of the 106th Congress, health care has emerged again in the national scene through the presidential candidates' statements. Critics of Gov. George W. bush's role on SCHIP as it was being created in Texas point out that he wanted coverage to go to families with incomes at 150% of the federal poverty level rather than 200%. The higher level was estimated to cover 200,000 more children. When health care advocates persuaded lawmakers to raise the level to 200% of the federal poverty level, Gov. Bush signed the SCHIP bill.
Vice President Al Gore has made expansion of SCHIP the centerpiece of his health care plan. He proposes to ensure that every child has access to health insurance by 2005 through expansion of the program to permit children in families with incomes above 250% of poverty to buy into SCHIP or Medicaid. Gore also wants to provide financial incentives to states for enrolling children in CHIP and expand CHIP coverage to an estimated 7 million uninsured parents of CHIP or Medicaid eligible children.

As the Presbyterian Church (U.S.A.) celebrates "The Year of the Child," the issue of children's health must not be overlooked. A vision for Children and the Church approved by the 205th General Assembly (1993) states, "We affirm that all children are a gift of God, created by God and created good." Federal and State officials have made a start in reducing the number of uninsured children, but there is also a role for community-based organizations- including religious organizations.

Because they are communities of faith, churches, synagogues and mosques and their members may be especially equipped to assist in the outreach to enroll eligible uninsured children. For example, a city in Ohio was contacted by a parish nurse inquiring how church members could become involved in the outreach process. The SCHIP official suggested a number of ways churches could participate. Communities of faith can inform and facilitate the process for those in their community who need this service. Religious bodies can also go into the communities of need and engage in outreach for SCHIP enrollment. Caring for the child can lead to outreach in the church, school, community or recreational centers and even malls. Remember, God's care for children is present wherever they may be found.

Presbyterian General Assembly policies still affirm health care principles of accessibility,affordability and quality. As a practical matter, however, children's health is more capable of eliciting bipartisan and bicameral support in Congress or a future administration.

Reducing the number of uninsured children is an issue that voters should lift up in the coming presidential and congressional elections. Legislators are key players if that is to happen. Strong administrative leadership that can work with congress is also needed. Public and private efforts--such as SCHIP outreach and enrollment aided by religious groups--can come together to provide healthier lives for our children. This is not a completely altruistic endeavor for healthy children make for a healthy nation. Health and Human Services secretary Donna Shalala has said, "Our children will be the architects of society in this new millennium. Healthy Children today means a healthier, more productive, more prosperous nation, tomorrow."

"SCHIP has been a sucess story because it's based on partnerships-partnerships between federal and state govenments and partnerships between the public and private sectors," said Shalala as she and Secretary of Education Richard W. Riley offered the administration's support for The Covering Kids Campaign funded by the Robert Wood Johnson foundation. The campaign is a three year, multi-million dollar national effort to inform parents with uninsured children who qualify for low-cost or free health care coverage that their children may be eligible and connect them to health care.

At an August 9 news conference, Steven Schroeder, president and CEO of the Robert Wood Johnson Foundation, told the audience that of the 11 million uninsured American children, 7 million of them could have health care coverage today. Approximately $47 million has already been contributed in grants to state and local initiatives to increase national outreach and enrollment efforts by the Foundation. In addition, the grants are being used to assist in streamlining each state's application and re-enrollment process.

The Foundation decided one of the best avenues to reach uninsured children is through the schools. The campaign is being launched during the back-to-school period because it is a natural time to reach out to parents who are preparing their children for the school year. Riley said, "As Secretary of Education, I am committed to outreach on children's health insurance because we cannot properly educate children if they are not healthy. We know that healthy children learn better and benefit more from education."

The Office of Health Ministries, USA of the Presbyterian Church (U.S.A.) is also providing resources for church committees and groups to become involved in outreach for enrollment in SCHIP programs. Resources include biblical, theological and worship materials. Also available will be advocacy materials developed by Children's defense Fund, Families USA and the PC(USA) Washington Office.

The following list provides some suggestions as to HOW YOUR CHURCH CAN HELP:

• offer your church building as a registration site;
  
• offer to contact other religious bodies in the area for registration sites;
  
• talk with local schools about the program, making sure guidance counselors and school nurses have good information;
  
• send your youth group out with fliers to post in groceries, restaurants and other high traffic places in the community;
  
• set up phone banks to help spread the word;
  
• write short news releases to go in church newsletters and local papers;
  
• help at registration sites

The outreach efforts are not just for faceless children. Some of these children live in your community!

Suggested actions:

1. The106th Congress is in recess until after Labor Day and is scheduled to adjourn in October. The best time to contact them, therefore, is in your home district. Since all seats of members of the House are up for election and also a third of the Senate, there will be heavy campaigning in the districts. Let them know of your concern for children's health. Urge their support of a more vigorous outreach to enroll eligible uninsured children into CHIP or Medicaid. If you are part of a religious effort to increase outreach, please let them know.

2. Use any of the suggestions for churches offered in this newsletter and publicize your efforts locally. Do this through articles placed in weekly or daily newspapers, radio talk shows or local cable programs. Be sure you have accurate information obtained through your local or state SCHIP program. Additional sources of information are the Families USA web site www.familiesusa.org and the Children's Defense Fund web site, www.childrensdefense.org/signup.

3. Obtain a copy of Health, Education, and Well-Being of Every Child, a statement of the 212th General Assembly (2000). It appears in the General Assembly edition of the July/August 2000 Church & Society magazine. It can be ordered from Presbyterian Distribution Service, (800) 524-2612. The statement is also in the minutes of the 2000 General Assembly.

4. Contact the PC(USA) Office of Health Ministries, USA to receive a packet on children's health. Call James Tippett at 1-888-728-7228, ext. 5789. The packet will contain useful worship and advocacy materials.

General Assembly Guidance

The 2000 General Assembly statement on "Health, Education, and Well-Being of Every Child" calls for Presbyterians to support" a healthy, fair, and safe environment." It also requests the Stated Clerk to ask presbyteries and synods to lobby their state and federal legislators "requesting that all mandates providing for the health, education, and well-being of all children be fully funded."