Insurance Companies Drop Child-Only Coverage

LA Times

 

Major health insurance companies in California and other states have decided to stop selling policies for children rather than comply with a new federal healthcare law that bars them from rejecting youngsters with preexisting medical conditions.

Anthem Blue Cross, Aetna Inc. and others will halt new child-only policies in California, Illinois, Florida, Connecticut and elsewhere as early as Thursday when provisions of the nation's new healthcare law take effect, including a requirement that insurers cover children under age 19 regardless of their health histories.

The action will apply only to new coverage sought for children and not to existing child-only plans, family policies or insurance provided to youngsters through their parents' employers. An estimated 80,000 California children currently without insurance — and as many as 500,000 nationwide — would be affected, according to experts.

Insurers said they were acting because the new federal requirement could create huge and unexpected costs for covering children. They said the rule might prompt parents to buy policies only after their kids became sick, producing a glut of ill youngsters to insure. As a result, they said, many companies would flee the marketplace, leaving behind a handful to shoulder a huge financial burden.

The insurers said they now sell relatively few child-only policies, and thus the changes will have a small effect on families.

"Unfortunately, this has created an un-level competitive environment," Anthem Blue Cross, California's largest for-profit insurer, said in a statement declaring its intention to "suspend the sale of child-only policies" on Thursday, six months after the healthcare overhaul was signed.

The change has angered lawmakers, regulators and healthcare advocates, who say it will force more families to enroll in already strained public insurance programs such as Medi-Cal for the poor in California.

The White House weighed in Tuesday, condemning Anthem corporate parent WellPoint Inc. and others that plan to stop selling child-only policies.

"It's obviously very unfortunate that insurance companies continue to make decisions on the backs of children and families that need their help," White House Press Secretary Robert Gibbs said at a news briefing.

The Obama administration had told insurers they could solve the problem by issuing policies only during designated enrollment periods. Some White House officials, however, noted that families who can't find policies might be able to sign up for high-risk pools being set up around the country as part of the new healthcare law.

In California, the stakes may be particularly high for insurers who abandon child-only policies. A bill awaiting Gov. Arnold Schwarzenegger's signature would bar such companies from selling insurance in the lucrative individual market for five years. A Schwarzenegger spokeswoman said the governor had not yet taken a position on the measure.

Assemblyman Mike Feuer (D- Los Angeles), the bill's author, voiced frustration over the insurers' plans and singled out Anthem Blue Cross, whose corporate parent notified brokers nationwide Friday of its decision to exit the child-only business in 10 states, including Colorado, Connecticut, Missouri, Nevada and Georgia as well as California health insurance quotes.

"At a time when we are launching a national approach to ensure that all children have access to healthcare, Anthem's actions represent a step backwards," Feuer said. "By threatening to drop child-only policies in California, the company jeopardizes the health of families and children. I call on Anthem to reconsider its plan."

Other regional and national insurers also plan to stop selling insurance policies exclusively for children. Among the companies is UnitedHealth Group Inc., the nation's largest insurer by revenue. It did not say which states would be affected.

"We continue to believe that regulations can be structured that will enable child-only plans to be offered, and we are working toward that goal," spokesman Tyler Mason said.

Aetna said that effective Oct. 1 it would no longer offer policies in the 32 states where it conducts business, including California, Florida, Illinois, Virginia and Pennsylvania.

Cigna Corp. will halt the policies in 10 states, including California, Arizona, Colorado, Tennessee and Texas.

"We made a decision to stop offering child-only policies to ensure that we can remain competitive in the 10 markets where we sell individual and family plans," Cigna spokeswoman Gwyn Dilday said. "We'll continue to evaluate this policy and could reconsider changing this position as market dynamics change."

The explanations left healthcare advocates fuming. They accused insurers of trying to skirt the law's new requirement to cover children with health problems.

"Insurers need to decide if they are in the business of providing care or denying coverage," said Anthony Wright, executive director of Health Access California, a consumer group. "In California, we hope our insurers come to an equitable compromise that allows access for all children and affordability for those with preexisting conditions."

In Colorado, regulators and insurance carriers are trying to work out such a compromise. The state's insurance commissioner met Friday with several insurers, including Anthem, Cigna and Aetna. The two sides did not reach an agreement, but officials remain hopeful they can broker a deal before Thursday.

"Obviously this deadline looms large," said Jo Donlin, director of external affairs for the Colorado Division of Insurance. "The commissioner wants families to have access to the insurance they need. Both sides of this want to find a solution."

Santa Clara County Pushes Measure to Rescue Children's Health Care

Mercury News

 

In an urgent attempt to maintain universal health coverage for children in Santa Clara County, community leaders are organizing a campaign to rescue one of the region's landmark programs for working poor families.

Their goal is to win broad support for a November ballot measure that would pump $13.5 million per year into the Healthy Kids program through a $29-a-year parcel tax on county property owners. County leaders recognize the challenge: Asking voters in a down economy to assist other families who can't afford insurance for their children.

The program — now serving 8,500 children — is a core piece of a far larger children's health initiative begun in 2001 and considered the first of its kind in the nation. Twenty-eight other counties have tried to mimic its success in linking 97 percent of children with heath insurance.

But that could quickly change, proponents of the November ballot measure warn, given the ailing economy's impact on private donors and foundations that  are critical to Healthy Kids' survival but drying up at the end of 2010.

Like so many other social welfare programs in California, coverage for uninsured children faces a dubious future if new funding streams are not found, said Kathleen King, Saratoga's mayor and executive director of the Santa Clara Valley Health Foundation.

"The foundations can't keep doing it with their donations," King said. "So these great programs are going to go away if we don't find another source."

King said backtracking would be devastating. When the children's health initiative began, one in eight kids in Santa Clara County lacked health insurance. Since then, 171,000 have been enrolled in one of three publicly funded insurance programs that provide medical, dental and vision coverage.

Families on the program call it a lifesaver.

"If Healthy Kids was not there, I don't think that I would be talking to you right now. You'd have no one to interview me about," said Rogelio Patingo, of San Jose, whose daughter was born with Down syndrome and has endured a lifetime of surgeries and monthly hospitalizations — much of it made possible through Healthy Kids.

He has worked seven days a week as an auto mechanic, taken evening classes to improve his craft and spent nights on the pediatric ward so his wife can leave their daughter's bedside to go home and shower. But Patingo cannot afford insurance for the couple's only child, whose lifelong ailments include a heart defect.

Now 12, Maria functions as a 7- or 8-year-old, but loves teeny-bopper sitcoms and music downloads.

"Because my daughter's condition is complicated, all of her doctors are specialists, so I don't think I could handle those specialist doctors," he said. Especially not in a market of rising California health insurance quotes.

Yet Healthy Kids' overall enrollment has been squeezed each month. As kids grow too old for the program when they turn 19, there is no funding to allow a newcomer the space, directors say. For more than three years, the program has been closed to new enrollees.

Santa Clara County's children's health initiative has three tiers for working poor families such as Patingo's. The poorest are enrolled in the state and federally funded Medi-Cal and Healthy Families programs. Those without employer-sponsored coverage who earn at least $66,150 per year — 300 percent of the federal poverty level for a family of four — are placed on the county-run Healthy Kids program.

The program is already unable to meet its costs, King said. About half of the Healthy Kids' $11 million budget comes from the county, local cities and tobacco taxes. Private foundations, individual donors and corporate sponsors have for the past decade made up the rest. But already this year, three top donors have pulled out $3 million in funding, and some public grants are looking iffy. Parents pay $4 to $21 a month per child, with a maximum cost of $63 per family.

The program's local and private funding grants it independence. Healthy Kids is the only program in the local health initiative that does not require proof of legal residency. Thus, many on the program will not be eligible for assistance under the recently passed national health care reform legislation.

Three out of four recipients live in two-parent working families and more than 90 percent of the children live with a working parent. A recent study of the county health initiative funded by the David and Lucile Packard Foundation found that kids on the program missed fewer school days, and repeated sick visits to the doctor dropped by 50 percent.

County Supervisor Ken Yeager said supervisors voted unanimously in May to place the parcel tax measure on the ballot because there are no other viable alternatives to assist these families. But, he conceded, given the down economy, it will not be easy reaching the two-thirds threshold required of ballot measures. Property owners may not want yet another bill to pay.

Contrary sentiment is already evident among some local conservatives.

"We feel that the property taxes are already too high in the area now due to a lot of wasteful spending by local government," said Paul Komarek-Crockett, president of the Santa Clara County Tea Party. "The program is important, but I disagree with taxing additionally the property owners."

Komarek-Crockett added that his group will not use its resources to actively campaign against the ballot measure, "but we've told our followers that we don't approve of it."

Early polling commissioned by the health foundation, however, says the ballot measure has a chance. The tax would run 10 years beginning in 2011 and would not go toward administrative costs.

"Our residents care very much about the health of children and are going to be willing to support this," Yeager predicted. "People understand that you can pay now or you can pay later — to provide children continuous health coverage in the long run is cheaper than having them in the emergency room."

Companies Urged to Follow new Ohio Health Law

Associated Press

 

Advocates for the uninsured are urging some of Ohio's biggest employers to follow a new state law that allows young adults to stay on their parents' health insurance until they turn 28, even though the companies are exempt.

The law, which takes effect July 1, makes Ohio one of the few states to exceed the extension to age 26 mandated by President Barack Obama's health care overhaul. Young adults have one of the highest uninsured rates, often because they can't find jobs or because employers don't offer health coverage for entry-level positions.

Ohio's new benefit, while broad, won't help children whose parents work at private, self-insured companies that pay their workers' medical claims directly rather than buy insurance. These firms, including Procter & Gamble Co. and Honda Motor Co., fall outside state regulation.

About 6.6 million Ohioans get health insurance through employer-based coverage, and about half of those are with employers that self-insure.

It's disappointing that some of Ohio's largest employers will not voluntarily extend coverage for young adults to age 28, said Cathy Levine, executive director of the Universal Health Care Action Network of Ohio.

"We all benefit from having more young adults, who tend to be low-cost, in the insurance pool," she said.

Self-insured companies generally have multistate operations, and to offer health benefits in Ohio that aren't available to employees and their children in other states could be very confusing and administratively difficult, said Carrie Haughawout, who tracks health care policy at the Ohio Chamber of Commerce.

For now, companies such as the Cleveland Clinic, which has 28,000 employees on its self-insured health plan, are sticking with the federal regulation and will cover dependents up to age 26 only. Same with Eaton Corp., a large Cleveland-based company that makes hydraulics and electrical equipment.

Procter & Gamble, the consumer products giant based in Cincinnati, declined to comment on future plans, and Honda, which has four major auto factories in Ohio, said it still is evaluating the state changes.

The new state law will definitely fill a gap for some young adults ages 26 to 28, said Brian Gay, a 26-year-old graduate student at Ohio State University.

"Without health insurance, you cross your fingers and hope nothing happens to you," said Gay, who graduates Sunday and is covered under a school-sponsored health plan for the next three months. He'll explore coverage options with his parents if he can't land a job this summer that offers health benefits.

Ohio previously allowed dependent children to stay on their parents' health insurance until age 19 — or age 23 for a full-time student. New York allows parents to continue covering children up to age 29 in certain cases; Florida and Nebraska up to age 30; and New Jersey 31.

The federal mandate to extend coverage for young adults up to age 26, regardless of a company's self-insurance status, takes effect Sept. 23. About 1.2 million young adults nationwide are expected to sign up, more than half of whom would have been uninsured.

Ohio's law complements that, although married children aren't eligible. The new benefit should allow about 20,000 additional young adults up to age 28 to have access to health insurance, according to state estimates.

It could be more if companies that are exempt agreed to meet the standard on their own.

State regulators are unaware of any self-insured companies voluntarily taking that step, said Carly Glick, spokeswoman at the Ohio Department of Insurance.

Companies aren't on the hook for paying the added cost of extending coverage for young adults to age 28. That falls on employees who enroll their children, and prices will vary depending on individual plans.

Government workers looking to add coverage for older children are among the biggest beneficiaries of Ohio's law, including employees of Ohio State University and the state of Ohio. Even though both operate self-insured health plans, they are public institutions subject to state regulation.

The state of Ohio has about 58,000 employees and provides insurance coverage to 120,000, which includes beneficiaries, said Ron Sylvester, spokesman at the state Department of Administrative Services.

The added cost for a state employee who wants to maintain on a dependent child until age 28 ranges from about $136 per month to $150 per month, he said. About 415 new dependents already have been enrolled for the new benefit, and 259 more additions are pending.

Health Insurance Reform Profiles

LA Times

A look at how the new law will affect four people in different circumstances.

DIFFERENT SITUATIONS: Alex Osvaldsson is a college senior covered, for now, by his parents' policy; Laura Carpenter has battled cancer and no longer has insurance. (Michael Robinson Chavez / Los Angeles Times; Robert Durell / For The Times)

 

 

Most Americans will be affected by the overhaul of the nation's health insurance — some more directly than others.

Here is a look at four people — an uninsured woman with a pre-existing condition, a man happy with his current insurance plan, a college student and a self-employed professional — and how the new healthcare legislation will likely affect each of them in both the short and long term.

Individual experiences will vary, but some glimpses of the future can be seen already.

Laura Carpenter, 56, uninsured, Tuolumne, Calif.

At the same time she battled non- Hodgkin's lymphoma, Carpenter fought with Aetna U.S. Healthcare about its repeated attempts to cancel her insurance policy.

She was cut off for the final time — in September 2004 — because of what she describes as a simple postal error. At that point, Carpenter, a former marketing manager, was left without the coverage that paid for most of her treatments — treatments that she believes ultimately helped her beat cancer.

Unable to find another plan she could afford, she's now been without insurance for more than five years. It's been that long too since she's seen a doctor for follow-up tests related to her diagnosis. For Carpenter, health reform is a very welcome turn of events

"When I heard it was going to pass, I was kind of blown away it actually happened," she says. "I'm feeling cautiously optimistic. At this point, it would seem almost too good to be true to have coverage again."

People with pre-existing health conditions, such as Carpenter, are among those with the most to gain from the impending changes to the health insurance system.

Within 90 days of the bill becoming law — around mid-June — a new, but temporary, national high-risk pool for people with pre-existing health conditions will be established, extending the option to buy coverage to those who have gone without insurance for six months or longer.

Starting in 2014, the high-risk pool will be eliminated as people gain access to insurance through a national exchange, says Anthony Wright, executive director of Health Access California, a statewide advocacy group. Carpenter will then be eligible to buy a policy through the exchange, with the guarantee that her coverage can never again be pulled away.

Carpenter has gone for years without recommended post-cancer treatment checkups. She looks forward to going for doctor visits she's long been unable to afford, and to putting her mind at ease.

"In the back of my mind, I keep thinking it will be worse down the road because I didn't take care of some things," she says. "I have a list as long as your arm of illnesses I've had related" to non-Hodgkin's lymphoma.

Upon becoming eligible for health insurance once again, she says, "I'll probably get the tests done right away that I should have had before."

Laurence Rudolph, 62, Herndon, Va.

Rudolph, an independent contractor, is happy with his health insurance as is. The Blue Cross Blue Shield plan pays for preventive care and diagnostic tests and is accepted by the primary care physician who has a long history with his family.

"My wife's plan is not cheap … but it is a good plan and well worth it," he said. "Peace of mind is worth a lot."

And nothing in this law will require him to change his current insurance, said Anthony Wright, executive director of Health Access California. Not only will he get to keep the coverage, which he has through his wife's job with Fairfax County Public Schoolshttp://www.fcps.edu/index.shtml, but the family policy also costs less than $27,500 annually, the threshold for being taxed as a so-called Cadillac plan.

The only changes Rudolph and others in similar situations' might see pertain to some basic coverage standards for employer and individual plans. These include prohibiting lifetime maximum benefits, which about 41% of employer plans currently have, according to a report funded by the California Endowment; limiting annual out-of-pocket costs at $5,950, affecting about 23% of employers; providing preventive services at no cost to plan members, which would affect about 10% of plans; and requiring prescription drug coverage for small employers.

When insurance exchanges are created in 2014, individuals who pay more than about 8% of their income could opt to leave their employer's plan, take their employer's subsidy and shop the exchanges. Wright said. People in low-wage jobs are the most likely to exercise this option.

"This is radical reform of the individual market and an evolution for the employer-based market," Wright said. "They focused on where the major problems are."

Unlike some Americans who are currently insured, Rudolph is confident the greater changes are all for the good.

"Society benefits from everyone having healthcare," he said. "If everyone had insurance, there is a better chance that they will be getting good care from their doctors."

Rudolph said he and his family are pleased with their current insurance — and they have not had any major medical problems with which to contend.

"Being part of a large group, they don't drop you," he said. "We have an emergency brake, but the whole notion is that you don't know until you pull that brake. There are a lot of people out there who think they have one, until they get sick and pull it and it's not there."

Some of Rudolph's concerns about healthcare reform include a potential rise in costs and a strain on doctors' offices by an influx of newly insured patients. Wright said one of the goals of the reform is to contain the growth in healthcare costs. He said approximately 10% of premiums go toward subsidizing care for the uninsured — so if reform covers a large portion of those individuals, premiums should eventually decline.

Alex Osvaldsson, 22, college student, Irvine

For Osvaldsson, a senior at UC Irvine, the insurance changes will come just in the nick of time. With his 23rd birthday and college graduation both coming up this June, he was about to lose two insurance policies: His parents' plan, which only allows dependent children coverage until the age of 18 or 23 if, like Osvaldsson, they are enrolled in college, and secondary insurance through UC Irvine's undergraduate student health insurance plan. That ends for Osvaldsson upon graduation.

"This is a lot of weight off my shoulders," he says about the passage of the healthcare bill and an included provision (scheduled to go into effect in six months) allowing young adults to remain on their parents' insurance plan until the age of 26. "I'd feel uneasy if I didn't have good coverage."

Young adults in their 20s comprise the group most likely to be uninsured, says Anthony Wright, executive director of Health Access California. "Some people wrongly attribute this to a phenomenon that they call ‘young invincible,' and the idea that young people somehow don't want coverage. They do want coverage but are more likely to be low income, going to school or have a job that doesn't provide it."

Upon graduation, Osvaldsson is planning to attend art school. Had healthcare reform not allowed him to remain on his parents' plan, he would have gone to the individual insurance market and California health insurance quotes for coverage. But without a full-time job, he would have needed his parents to pay for it.

Even without chronic illnesses or a history of health problems, the expense would have been $93 each month, with only one paid doctor's visit a year and a $2,900 deductible.

"I wouldn't be able to pay that on my own. [My parents] are in a position to do that, but if they were really hurting right now, I would have either taken the risk and opted out or looked for work instead of going further in school."

Still, Osvaldsson will have to find a way to bridge the gap in coverage between his 23rd birthday in June and the provision kicking in sometime in September — and possibly longer — depending upon when his parents' plan has open enrollment.

Osvaldsson is pleased about the bill's passage as he thinks ahead to a day when his now-perfect health may change.

"I think [not being able to deny coverage] for pre-existing conditions is great," he says of the health reform bill. "If down the road I develop a condition, I won't have to worry about being dropped or not covered because I need services."

Geoff Williams, 40, self-employed, Loveland, Ohio

Freelance writer Williams has a high-deductible health insurance plan coupled with a health savings account for his family of four. Should any of them experience a major health problem, he could end up paying a maximum of $12,000 a year in medical expenses between his premiums and the deductible.

Williams, who has been self-employed since 1997, purchases insurance on the individual market. His former "affordable but crummy" insurance, also bought on the open market, left him paying off his daughter's eye surgery four years after the procedure. He increased his benefits until his premiums hit $1,200 monthly two years ago, when he switched to the plan he has now. It costs $500 a month and has a $6,000 annual deductible. The plan pays for some preventive care, such as an annual physical, but Williams pays more than he would on "a regular plan" for other physician visits.

This is the roller-coaster ride that many individuals take annually — watching premiums and deductibles increase while benefits decrease. And this is why Williams was "thrilled" to see the healthcare overhaul signed into law.

"I honestly have no idea if it will be better or not, but the system seems pretty broken for the self-employed and people with pre-existing conditions," he said. "I think something had to be done, so I applaud them. I'm optimistic."

People shopping the individual market will be affected greatly by the reform. They can no longer be denied insurance due to pre-existing conditions and, if they make $88,200 a year or less for a family of four, will be eligible for subsidies to help pay for coverage.

"I wouldn't turn down any subsidy, and I think if you're going to insist that people have health insurance — and if health insurance rates don't come down — the government probably will have to offer some subsidies," he said.

The individual market is currently the least efficient and most expensive way to get coverage, said Anthony Wright, executive director of Health Access California. The health insurance exchanges, scheduled to start in 2014, will likely give individuals market power and better rates, he said.

"If they create an exchange, I would look into it," Williams said, adding that his current plan "is kind of the poor man's health insurance, but it is working for us. But at the same time, I may jettison it if I can."

Questionable Future for State Health Plans

Many individuals are embracing the summer season with fear. A Washington state health insurance program for low-income adults is planning to close, ending insurance coverage for about 65,000 individuals.

The ill economy is forcing Washington state as well as many other states to shave their health insurance programs for low-income people, even as jobless motives are demanding help. Five of the six states that

utilize state funds to help adults who are not covered by Medicaid are considering cuts. These program cuts are barring new enrollment or raising fees.

The 250,000 individuals taking advantage of the state programs are adults who do not qualify for the federal-state Medicaid program. This is either because they have no children or have earnings exceeding the limits which state imposes on Medicaid eligibility. The number of adults represent a small fraction of those who get government health insurance coverage, even though the state programs are often their only option for health coverage.

Individuals are taking action to counter the state's insurance cuts. For example, in California, many are consulting insurance brokers for Medigap insurance quotes to fill the coverage gaps of Medicare. This type of plan is also known as supplemental insurance.

The U.S. Senate passed a health bill that does include funding for the state programs. That bill, along with a bill the House of Representatives passed, would also expand Medicaid and provide federal subsidies to help low-income and middle-income Americans acquire affordable insurance. The bill's fate is uncertain as Democrats regroup after a recent loss in a key Senate seat.

Even if the bill is approved, the relief for states, as well as the uninsured population, is years away. For this reason, experts are advising the uninsured to be prepared and obtain personal health insurance quotes from several insurance providers.

Potential Stimulus Protection

Stimulus money from the Federal government has sheltered many state Medicaid programs. However that funding is set to run out in December and could result in Medicaid eligibility cuts, on top of potential cuts in states' adult health programs.

A Washington senator added a provision to the Senate health bill to permit a state to find federal funds for Basic Health until 2014. The senators spokesman says the provision would apply to other states with basic health insurance plans.

A second Cantwell amendment would allow states to form basic health insurance plans after 2014. These plans would be available to individuals who earn over the limit for Medicaid but less than twice the poverty level.

Many insurance experts say such state insurance plans would not be needed if a healthcare overhaul passes. This is because most individuals who qualify would suit the new Medicaid enrollment guidelines or qualify for federal subsidies.

"There will be no reason for states to pay for this themselves," says an expert at the Urban Institute.

However, an overhaul is still up in the air. Until then, policy experts recommend shopping for individual health insurance with the best benefits.

Whatever the outcome of the debate at the capital, policy experts cross their fingers that lawmakers can seek the money to save Basic Health.

For more information on how to protect yourself with affordable, health insurance coverage, consult a policy expert to better understand your insurance options.

17,000 Child Deaths Linked To Lack Of Insurance

Kids without coverage are more apt to die while hospitalized, study finds
U.S. News & World Report

An estimated 17,000 children in the United States might have died unnecessarily over nearly two decades because they didn't have health insurance, according to a report from researchers at Johns Hopkins Children's Center in Baltimore.

They found that kids who lacked health insurance were 60 percent more likely to die in the hospital than were kids who had insurance. After adjusting for such differences as race and gender, uninsured kids were still 37.8 percent more likely to die than kids with insurance coverage.

David C. Chang, co-director of the pediatric surgery outcomes research group at Hopkins and a study co-author, said he could not think of a medical treatment that has such a dramatic impact on health outcomes as health insurance seemingly does.

"This is actually something we as a society ... can choose to do something about," he said. "It's literally with the stroke of somebody's pen, this could be changed."

The article was published online Oct. 30 in the Journal of Public Health.

Bruce Lesley, president of First Focus, a bipartisan child and family advocacy group, noted that data from the U.S. Institute of Medicine have shown that people who are uninsured have a higher mortality rate.

"You knew that it existed, you knew that there were cases [of child deaths related to lack of insurance], but I think this data is pretty shocking and really points to the need for national health reform," Lesley said.

In one of his first acts after taking office in January, President Barack Obama signed legislation reauthorizing the Children's Health Insurance Program (CHIP). The measure also provided funding for states to add several million more children to the rolls though 2013.

"CHIP has really worked and been very important and insures about 7 million kids in the country," Lesley said. Still, he said, roughly 6.5 million children who are eligible for Medicaid or CHIP remain uninsured -- for whatever reason.

Enrollment barriers are part of the problem, explained Lesley, whose organization endorses legislative proposals to move toward a "default enrollment" system. "The presumption should be the kid's enrolled, and let's figure out what program they're in," he said.

The Johns Hopkins team looked at the relationship between insurance status and kids' mortality to better inform the CHIP debate.

Using records from two large databases, lead author Dr. Fizan Abdullah, Chang and colleagues examined more than 23 million hospitalizations of people younger than 18.

Over an 18-year period though 2005, 117 million children were hospitalized - in standard and children's hospitals. Nearly 6 million kids were uninsured at the time of admission. In all, 38,649 children died while hospitalized.

Uninsured kids were 1.6 times more likely to die than children who had insurance.

Assuming that the insured and uninsured populations are identical, the difference in risk of mortality was 60 percent. The authors' actual predicted mortality is lower, however, because factors such as age, race and gender are associated with risks that affect outcomes, Chang explained.

"The 60 percent is the theoretical difference, and the 37 percent is the actual difference that you see in real life," he said. "Our extrapolation is based on that more conservative number."

The study includes some data from the period before CHIP was enacted in 1997. Though fewer kids are uninsured today than two decades ago, Chang said, that would not skew the risk of death from lack of insurance.

And though the study does not prove that being uninsured boosts a child's mortality risk, it does suggest a strong association between insurance status and odds of dying.

"I think the message is insurance is a choice we can make as a society, and this is something that we should consider," Chang said.