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Sara Rosenbaum Discusses Children's Healthcare


Children's healthcare is more than just the Children's Health Insurance Program (CHIP). The area of children's health policy is one that is largely misunderstood, said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy and founding chair of the Department of Health Policy at the Milken Institute School of Public Health, George Washington University.


What is being left out of or not being discussed in any policy debates about children’s healthcare in the US?

The question of sort of how do we think about children’s healthcare, children’s health policy, is one of those issues that has been, I would say, misunderstood for all the years that I have been working on children’s health policy, which is a long time now. We tend to boil it down to CHIP and CHIP, of course, is extremely important and Congress fortunately extended the funding for CHIP back at the very beginning of February now, end of January. And that stabilizes coverage for about 9 million children.

Of course, there are about another 36 million children or so in that part of public insurance that we know as Medicaid and some of the CHIP children are Medicaid children. So, the bigger discussion we are not having is one that takes a step back and looks at the panoramic situation of children and health insurance in the United States today and what you see is that of course we are in a very long, slow, but steady decline in terms of children’s access to their parents plans and this very long shift that began as the decline became apparent towards children in public insurance.

So, the discussion needs to be more than just are we going to fund CHIP, the little slice of public financing, but what can we do to make public insurance for children stronger? How do we make sure children remain stably covered? How do we make sure they get the scope of coverage they need and how do we use financing to generate a movement toward healthcare systems that can interact particularly well with schools, child welfare, and other services that children use?

What lessons do you think we learned form the recent battle over reauthorizing funding for CHIP?

Well, I would say lesson #1 is the next time somebody tries to sell you a Medicaid block grant, think twice. All of the block grant legislation, just like CHIP, tend to be time-regulated blocks that have to be extended and in the CHIP battle which after all was a teeny, tiny program in terms of the overall funding think about what would happen to states if suddenly the ending of a $3 trillion program was reached. What would you do at that point? I would say that the big takeaway lesson is that when the federal government tries to restate its partnership in indogen health care as we will give you some money and get out of your way, don’t believe it.

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