Issue:

More than 11 million children, one in seven, lack health insurance coverage despite recent state and federal expansions in children's health insurance programs. For both Medicaid and the State Children's Health Insurance Program [SCHIP], the principle issue this year is development of strategies to increase the enrollment of eligible children. In the aftermath of the 1996 welfare reform law, nearly 700,000 low-income people [62% children] lost Medicaid coverage and became uninsured. The high uninsured rate among children of noncitizen families is also a cause of concern. In 1997, the uninsured rate for citizen children living with noncitizen parents was 27%, compared to 23% in 1995. Nearly half [49%] of noncitizen children in families with incomes below the poverty line had no health care coverage in 1997.

State Children's Health Insurance Program: Created in 1997, SCHIP enables states to offer insurance coverage to children from working families whose incomes are too high to qualify for Medicaid but too low to afford private health insurance. The number of children enrolled in SCHIP has increased to nearly 2 million. Thirty states have approved plans that cover children in families with incomes up to 200% of poverty. Despite these positive trends, millions of eligible children are not enrolled in either SCHIP orMedicaid. While SCHIP can not cover children eligible for Medicaid, it can identify those children and assist them in enrolling in Medicaid.

Medicaid: In many states, parents are ineligible for Medicaid even if they are earning less than the poverty level. Eligibility for parents varies from a low of 22% of the federal poverty level in Alabama to a high of 275% of poverty in Minnesota. However their children, in many cases, remain eligible for Medicaid because of the higher income levels required by federal law. Federal law requires states to provide Medicaid eligibility to children under age 6 up to 133% of poverty; children age 6 and over [phased in through 2002] up to 100% of poverty.

Environmental Health: The unborn, infants and young children are generally considered more sensitive than adults to environmental hazards and toxins. Children's behavior patterns and certain aspects of their physiology lead to greater exposure to toxins and pollutants than that experienced by an average adult. Because children eat more food, drink more water and breathe more air as a percentage of their body weight than adults, they receive a greater dose of whatever chemicals are present in the food, water and air. In addition the risks of poor children may be exacerbated by conditions such as the lack of adequate medical attention, undernourishment or malnourishment, or crowded or unsanitary living conditions.

Children's greater susceptibility to the harmful effects of air pollution is well supported by scientific research. The lungs of newborns and infants are less developed and often lack the mature immune system defenses found in older children and adults. Children have greater exposure to air pollution than to adults. Children take in more air relative to their body weights and lung surface area than do adults and they spend more time outdoors than any other age group. While outdoors, children are more active, leading to increased oxygen demand and raising breathing rates significantly. Children also have greater physiological vulnerability because their lungs grow rapidly in both size and complexity during childhood. During this period of development, damage to the lungs not only affects the tissues themselves, but can also impede the further development of tissues and biochemical mechanisms in the lung.

In addition, during the past twenty years there has been a dramatic upsurge in asthma, that cannot be explained by improvements in disease tracking, diagnosis, treatment, and access to health care. More people are being hospitalized for asthma and more people are dying as a result of asthma attacks. While there is uncertainty about the connection between air pollution and the increase in asthma cases, numerous studies do show links between asthma attacks and air pollution levels.


Our Position:

Certainly among the weakest and most vulnerable members of our society are our children, born and unborn. As Pope John Paul II said in Familiaris Consortio, ‘In the Christian view, our treatment of children becomes a measure of our fidelity to the Lord himself.' [Putting Children and Families First, p.1] While childhood should be a happy, secure, and safe time of growth and development, for too many children it is not. "The lives, dignity, rights and hopes of literally millions of children are at risk." [Putting Children and Families First, p.1] Although there are many reasons for society's failure to protect and nurture children, one of the reasons is our failure to assure access to affordable comprehensive health care for all children.

In addition, in response to the growing body of evidence that children are at greater risk than adults from environmental health hazards, the United States Conference of Catholic Bishops's Domestic Policy Office (DPO) and Environmental Justice Program (EJP) are taking steps to address this serious concern. DPO/EJP has begun to pull together major Catholic health, social service and policy organizations to develop a cohesive and coordinated plan of action. This plan calls for successive but interrelated phases that can bring considerable resources to bear. The ultimate goals are to bring relief to effected children, their families and communities; to inform and educate the larger Catholic community of the salience of this issue, thus building a constituency of concern; and to promote institutional reform and public policies that can prevent and ameliorate this problem. These efforts have been underwritten by a grant from the National Religious Partnership for the Environment.


What You Can Do:

SCHIP and Medicaid: Urge members of Congress and your state leaders to simplify the rules and procedures for application to both SCHIP and Medicaid. They can do this by:

• accelerating enrollment in SCHIP or Medicaid of children already participating in other income-eligible publicly funded programs, e.g. WIC or school lunch;
  
• eliminating the asset test before enrollment;
  
• using simple eligibility requirements and a mail-in application; and
  
• redetermining eligibility no more than once a year.

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