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

How Public Health Insurance Programs for Children Work
Kirsten Wysen Cynthia Pernice Trish Riley


Despite the disturbing fact that approximately 9 million children in the United States lack insurance, without public programs such as Medicaid and the State Children's Health Insurance Program (SCHIP), many millions more would be uninsured. Since 1965, Medicaid has provided states with funding and a framework to provide a comprehensive set of health services to needy children and adults. More recently, since SCHIP's implementation in 1997, states have had another tool at their disposal with which to simplify and expand children's coverage. Through state policy decisions, each state has created a unique configuration of services and populations.

This article reviews the entire spectrum of coverage for children in the United States: private and public health insurance, and no health insurance. It places particular emphasis on the main features of Medicaid and SCHIP. The ways that these programs have influenced and benefited each other are also considered, as well as their comparative strengths and weaknesses. In addition, the article discusses innovations that have emerged as states have experimented with different ways to provide health coverage to children. It concludes by considering the implications of increasing fiscal pressures on programs, and the progress that states have made in covering children.