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Journal Issue: Health Insurance for Children Volume 13 Number 1 Spring 2003

Historical Overview of Children's Health Care Coverage
Cindy Mann Diane Rowland Rachel Garfield


America's public health insurance programs reflect a deeply rooted commitment to caring for low-income families and children. This article chronicles the evolution of Medicaid and the State Children's Health Insurance Program (SCHIP), two public programs designed to provide free or low-cost health coverage to low-income children who do not have access to private health insurance. Such a historical overview is key to understanding where the programs come from and the challenges that policymakers must grapple with in order to effectively provide health coverage to children.

Depression-era maternal and child health programs created the foundation for Medicaid. Expansions of the program during the 1980s and 1990s made Medicaid the largest single insurance provider for children in the United States. In 1997, SCHIP boosted these efforts by filling the gap between Medicaid and employment-based coverage. In addition to expanding coverage, SCHIP also motivated efforts to address obstacles to coverage such as application and enrollment procedures. Together, SCHIP and Medicaid have made significant progress in providing health coverage to children in low-income families. They are the primary sources of coverage for children in low-income families.

In a discussion of major challenges to providing public health coverage to children, the authors highlight some important issues that threaten current progress, such as rising health care costs and falling state revenues, gaps in coverage, and remaining barriers to enrollment and retention.