Prepared by Teresa A. Coughlin and Mindy Cohen of The Urban Institute
Kaiser Commission on Medicaid and the Uninsured
August 2007
In the summer of 2006, Illinois joined several other states in advancing health care reform by launching the nation’s first universal coverage program for children. Called “All Kids,” the initiative builds on the state’s Medicaid and State Children’s Health Insurance Program (SCHIP) programs but is funded exclusively with state funds. The program offers coverage to all uninsured children, regardless of income, health status or citizenship.
As of April 2007, about 50,000 children have enrolled in the expansion part of the All Kids initiative. About half are in households with income less than 200 percent of the FPL. Many of these are immigrant children who do not yet qualify for Medicaid and SCHIP because of program citizenship and immigration requirements. Most of the remaining new enrollment has occurred in the low-to moderate-income groups but some children in the higher income groups have also enrolled. About 100 children with $100,000 or greater family income have enrolled. Prior to the All Kids expansion, the state estimated that there were about 250,000 uninsured children across all income groups in Illinois.
By all accounts and by enrollment numbers, program outreach for All Kids has been a success. In large part, this success was attributed to the considerable campaign the state undertook to market All Kids, one that used a range of innovative strategies. The state’s streamlined application and follow-up processing, which includes a new online option, also likely contributed to the program’s enrollment success. Another likely important factor is the state’s decision to incorporate the expansion directly into its Medicaid and SCHIP programs and then market all under the single umbrella name of All Kids. In short, the outreach, the application process and the integrated program, make All Kids customer friendly and easy to understand.
Materials released by the governor’s office when the proposal was unveiled state that All Kids was designed to provide access to “good, affordable,” and “comprehensive” coverage to the state’s more than 250,000 uninsured children.
In terms of enrollment, All Kids has been a great success: Implemented July 2006, the initiative had a goal of expanding coverage to 50,000 children in the first year. Within nine months of implementation (April 2007), it had already reached that enrollment target.
http://www.kff.org/uninsured/upload/7677.pdf
Comment:
By Don McCanne, MD
Illinois’ All Kids was developed and promoted as a program that would provide health insurance coverage for all children in the state. A goal was set to cover 50,000 (one-fifth) of the uninsured children within the first year. This report celebrates the success of this program in that it achieved this target in only nine months. But is a celebration really warranted?
Before answering that, it is important to acknowledge that insuring 50,000 children who previously had no coverage is a good thing. But incrementalism is a bad thing when another 200,000 children are left without coverage.
When this program was established, it was very clear that there were many design flaws that made it virtually impossible to extend coverage to all uninsured children. Some of these flaws were covered in a Quote of the Day message over a year ago (link below). Although the current report celebrates the “race to the top,” a careful reading of the report confirms that the design flaws had their fully predictable negative impacts. In fact, it is clear from reading this report that it is improbable that coverage would ever be expanded to much more than one-fifth or one-fourth of the population of uninsured children.
Although it is now only one year into the program, it is safe to say that it is a failure. Establishing an artificial goal of accomplishing only one-fifth of the intended results does not entitle you to declare success merely because you reached that deficient goal.
It is important to understand that the failure was in the design of the program. Health policy science has advanced to the degree that outcomes of most policies are quite predictable. It is an egregious error on the part of politicians and the policy community to proceed with programs with fully predictable adverse results. To say that we should just go ahead with this program anyway and see how it works is health policy malpractice.
Illinois will never insure all of the children until they enact a program that results in automatic and permanent enrollment of every single child.
Likewise we will never insure everyone in the United States until we enact a program that results in automatic and permanent enrollment of every single individual. Those in the single payer reform movement can describe the policies that would make that happen. And it wouldn’t be necessary to test it them see if they would work.
qotd: Illinois’ dubious claim of first to cover all kids:
https://pnhp.org/news/2006/june/illinois_dubious_cl.php
