Rural children’s health insurance in jeopardy

Rural children’s health insurance in jeopardy

Boston Globe, July 18, 2007

THROUGHOUT social history, trends have started in cities and spread to rural areas. Today, however, we may be seeing a case where the reverse is true.

The shift from employer-sponsored health insurance to public-sector health insurance is being led by rural families. Among rural children in low-income families, the share covered by public-sector health insurance increased from 38 percent in 1998 to 54 percent in 2005, while children covered through parents’ employers fell by 10 percentage points over the same period.

Quietly, our bucolic Main Street has become a place where too many families struggle to make ends meet — often without a safety net — in a rapidly changing economy. Rural areas are hit hard by the loss of stable middle-class employment as foreign competition and lower wages overseas vie for these industries.

While many think of Detroit, Cleveland, or Pittsburgh as the manufacturing centers of the country, in fact, manufacturing jobs are a bigger share of rural employment than urban employment. Many of these are small manufacturing companies that are especially vulnerable to the changing economic tide. Too often stable, well-paying manufacturing jobs are replaced with less steady service-sector work with few benefits.

As Carsey Institute research shows, three-quarters of the 1.3 million uninsured children in rural areas are from families where at least one adult works full time, year-round.

Rural children remain the most vulnerable to the inequities that plague low-income families. Nearly half of all children in rural areas live in low-income families, and rural children are more likely to live in poor and near-poor families than their urban counterparts. According to the 2005 American Community Survey, 23 percent of rural children live in poverty compared with 18 percent of urban children.

For rural children, the situation is only getting worse. Between 2000 and 2005 rural child poverty rates increased in 41 states. A new report from the Carsey Institute at the University of New Hampshire shows that rural children also depend more on the State Children’s Health Insurance Program, or SCHIP, and Medicaid than children in urban areas. The rise in such coverage is also more pronounced in rural areas.

As the cost of health care continues to rise, low-wage or part-time jobs — often the only option for the many low-skilled workers in rural America — are unlikely to provide health care coverage. Presently 4 million children in rural America receive SCHIP or Medicaid, and nationwide 28 million children receive assistance from these programs.

Congress is planning to spend an additional $10 billion a year over the next five years to expand the State Children’s Health Insurance Program to reach some of the 9 million uninsured children in this country. The White House is offering an increase of less than $1 billion a year from current levels. Government estimates indicate that the funding level being offered by the White House will result in millions of children losing SCHIP coverage by 2012 as inflation eats away at the ability of the program to cover children .

Sorting out this health care crisis will take political will — and, no doubt, time. However, for the 9 million uninsured children, many of them with two working parents, we cannot wait a day longer. We have at our fingertips an effective program to insure children of our working families, but its future hangs in the balance.

Run by states with state and federal money, SCHIP today insures roughly 6 million children whose families earn too much to qualify for Medicaid but who are often in low-wage jobs that lack health insurance. Enacted in 1997, the program has been a resounding success. Together with Medicaid, it has reduced the rate of uninsured children by nearly a quarter over the past 10 years.

Providing health insurance to children is an investment in the future, and the majority of Americans, according to a recent survey, say the federal government should guarantee health insurance for children, and many are willing to pay higher taxes to do so.

As Congress considers reauthorization and funding of the State Children’s Health Insurance Program , it should keep in mind the critical role the program plays in the lives of many children. It is also important to recognize that this program will become even more critical for low-income children living in rural America in the years ahead as economic restructuring continues to diminish the number of stable well-paying jobs for rural families.

William O’Hare is a fellow and Cynthia M. Duncan is director of the Carsey Institute at University of New Hampshire.  

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