Legislation is often verbose and unclear, sometimes leaving unintended loopholes that can be exploited by special interests. But other times the language is chillingly spare and ruthlessly direct.
Like many states across the country that were taking up the charge to “Cover All Kids” and extend health care coverage to all children, Pennsylvania, in 2007, greatly expanded its Children’s Health Insurance Program (CHIP).
But a mere 13 words in the legislation thwarted these expansion efforts from truly covering all kids, heaping high costs upon struggling families they cannot afford to bear.
Children who do “not meet the citizenship requirements of Title XXI of the Social Security Act” are ineligible for enrollment in public health insurance — effectively excluding all undocumented immigrant kids throughout Pennsylvania.
This is no loophole, but just a hole that swallows the commonwealth’s 24,000 undocumented and uninsured children, depriving them of access to basic health care — unconscionable in non-pandemic times; potentially lethal under the long shadow of covid-19.
Undocumented immigrant workers on the front lines of this crisis are among our most at-risk of infection as their jobs are typically categorized as “essential.” They bring that risk home to their children.
Aside from the very real consequences facing undocumented families and their children, these 13 words are costing the commonwealth significantly more than what it would take to simply provide coverage to these kids. The fact is that when they get sick, they still receive medical care, and that care is more costly than it would have been had they been insured.
An article in the Journal of the American Medical Association highlights the major problem with neglecting the uninsured: unnecessary ER visits and hospitalizations.
In “Immigrant Health, Value-Based Care, and Emergency Medicaid Reform,” lack of health coverage “creates an environment favoring catastrophic and hospital-based care over ambulatory and primary care.”
Without regular access to health care, children end up in emergency rooms for health crises that could have easily been remedied or detected through regular check-ups. In fact, uncompensated care for children without health insurance is nearly double what it would cost the state to cover a child through CHIP.
Fiscal prudence demands that the commonwealth extend coverage to all kids to avoid the hefty responsibility of uncompensated medical costs, which would align with U.S. Health and Human Services Secretary Alex Azar’s focus on value-based care.
Expanding health insurance coverage to all of Pennsylvania’s children, regardless of immigration status, could have a significant impact on all children and their broader communities. Consider a typical classroom setting, even with coronavirus precautions in place, where parents would be hard pressed not to worry about whatever stomach bug is circulating that week. And suddenly, it’s your child who is affected by another child’s lack of insurance coverage and access to a regular check-up.
By expanding CHIP to include all children regardless of immigration status, Pennsylvania would join the likes of California, Illinois, Massachusetts, Nevada, New York, Washington and D.C. that have all adopted legislation to truly “Cover All Kids.”
In our region, major health care and child-serving organizations, like UPMC Children’s Hospital of Pittsburgh, Allies for Children, the Consumer Health Coalition, the Western Pennsylvania Annual Conference of the United Methodists and the YWCA of Greater Pittsburgh all back this vital effort — along with the Hospital Association of Pennsylvania.
Plugging this hole and putting an end to the economic waste and working to ensure that all children will be healthier should be among the highest of priorities — especially amid a global pandemic where an effective public health approach will likely mean the difference between success and prolonged failure. This is the time to act for the solution that we, and our children, need.
Dr. Robert Cicco is past president of the Allegheny County Medical Society, past president of the Pennsylvania Chapter of the American Academy of Pediatrics and former Pennsylvania Partnerships for Children board chair.
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