The brave new bipartisan world of health care reform: how will low-income families with children with special health care needs fare?

Abstract

“Insurance for Children With Special Health Care Needs: Patterns of Coverage and Burden on Families to Provide Adequate Insurance,” published in this issue of Pediatrics ,1 sheds some light on an important question: how would low-income families with children with special health care needs (CSHCN) fare if their children were privately insured rather than enrolled in Medicaid? Amy Davidoff from the Health Policy Center of the Urban Institute provides us with information that has special child health policy relevance given an emerging bipartisan approach to health care reform. In this approach, tax credits, possibly combined with a mandate, would be used to purchase private health insurance. Our current employer-based insurance system would transition to one in which individuals select their health plan in a competitive private market. Tax credits would function as an income-adjusted premium subsidy with qualifying low-income individuals and families receiving a refundable tax credit or transfer payment. Families would probably not receive money; instead, the transfer payment would be like a health insurance voucher redeemable for enrollment in a “reasonable” qualifying health plan. These health plans would be required to offer affordable group rates with community rating. Advocates of this approach would like the initial phase to include children who are enrolled in Medicaid and state children’s health insurance … Reprint requests to (S.B.) Children’s Hospital, 1056 E 19th Ave, B032, Denver, CO 80218. E-mail: berman.stephen{at}tchden.org