There are 75 million kids, ages 0-18, in the US today.
54% of them have health insurance through their parents, 41% are insured through Medicaid or other public programs, and 5% remain uninsured.
Tomorrow all of them can and should be covered by Medicare.
As a Progressive ultimately interested in universal health care, I argue that covering kids next is easier, less expensive, more impactful, and a better “test” of universal healthcare than any of the Democratic Presidential candidates’ healthcare policy prescriptions. It’s also morally and politically attractive across the conservative-moderate-liberal spectrum, and therefore a much more likely next step.
Why Universal Health Care? Because…
- Basic health care is a basic human right;
- It’s the superior administrative method to manage a marketplace for cost-efficiency and availability of pharmaceuticals and core services;
- It’s the only way to break the expensive and inefficient connection between health insurance and employer/employment;
- It can be implemented together with private services and insurance programs that supplement where required/desired.
How is it easier than Medicare for All and/or All Who Want It?
We know it’s easier because we’ve been doing it for 20+ years through the Children’s Health Insurance Program (CHIP), passed and reauthorized multiple times with bipartisan support, most recently with President Trump’s signature in Feb. 2018 extending the program through 2027. All states run it, with their own names and their own eligibility, supplemental coverage, and cost parameters unique to each state to assist those with incomes too high to qualify for Medicaid and too low to buy on the subsidized ACA markets.
And it’s “good” insurance, covering doctor visits, immunizations, emergency care, dental and vision, mental health, prescriptions and a score of other services that, again, are determined by each state’s local decisions. Some states have a sliding scale for premiums. Most states require some patient cost-sharing with co-pays. All states cap out-of-pocket expenses at 5% of a family’s income.
We know we can do it because we’ve done it, starting with 1 million kids in 1997 and growing to today’s 9.6 million enrollment, about one-third of the kids on public health programs today.
We also know how much it will cost because Medicaid spends ~$2,600 per kid and CHIP spends $1,852 according to most recent data. My math says it would cost, using the higher Medicaid numbers, about $197B a year to provide good health insurance to all kids under current program parameters. So how do we pay for that?
We’re already spending $107B per year through Medicare and CHIP, so simply transferring those revenues gets us more than halfway there. Who pays the remaining $90B?
Obviously employers and families buying their own insurance are currently paying the difference. Can we somehow transfer that money to the Medicare for All Kids program? Should we?
I’d answer “no” and “no”. The “transfer” of costs presents too many complicated scenarios in search of an impossible standard of fairness that make it a non-starter that would sink policy discussions.
Instead, I’d focus on relieving companies and self-employed families of their current burden for their kids’ insurance and let them decide how best to use the windfall. Companies could (and should) simply move those people expenses from the “benefits” line to the “wages” line for all workers. If employers decide to keep the windfall for other purposes, they’d have to explain it to their employees the same way they explain changes to their overall compensation packages today.
So who pays?
CHIP is funded mostly through taxes on tobacco. That’s right … smokers pay for kids’ health insurance today. While sin taxes are easy candidates for new revenue sources, it does not seem practical or wise to extend that practice in this case.
In an effort to keep costs as closely aligned to those who benefit most directly, we could abolish the current $2,000 child tax credit and raise almost $60B per year. After all, those claiming the credit today would receive a similar dollar amount health benefit, while those without kids are not required to pay anything. Seems fair. Yet the tax credit program’s success in pulling families out of poverty, coupled with the significant political allegiances it enjoys, likely makes this effort to align cost and benefit highly problematic.
So if we think about children’s health as we do children’s education, we can broaden our view of beneficiaries and assert that as educated children benefit society in general, so do healthy children. We all agreed a long time ago to use property taxes, income taxes, sales taxes, parental fees, and some federal subsidies to fund education for every kid in every state, consistent with that state’s local views and decisions as to amount and mix. So why not expect states to do the same for healthcare?
Well … they can’t. And many won’t. So the effort at a coordinated program in all states will at best be delayed, and more likely never come to fruition due to the complexity and challenges to get each state to fund children’s healthcare in addition to their education needs.
Medicare for All Kids needs, and deserves, a new source of revenue. The Financial Transaction Tax, a micro-percentage of stock, bond and other equity trade values has been discussed in Congress since 2009 and a part of nearly every Democratic Presidential candidate’s policy prescriptions today. I suggest it’s a perfect source to fund the needed $80B. Most current proposals result in total new revenues of $150B or more, depending on transactions covered and rates applied, so only half of the FTT’s revenue need be allocated to children’s health insurance. It’s also an easy tax to adjust, and it’s an easy tax to collect. Let investors in companies pay for the health insurance of their future employees and customers.
So we know we can implement the program. We know what it costs. And now we know we can pay for it. What’s next?
Clearly there are a host of important detailed policy coverage questions to consider and resolve, most of which are answered by simply saying “cover what CHIP covers today in the way CHIP covers it” and we’ll evolve as we learn more. So to those who need to know how kids of undocumented workers are treated, is neonatal support included for mother and child, or is abortion and/or birth control covered, and what about gender transitions, college or trades students older than 18, or this, or that … there are current answers for each state today that are an accepted and acceptable start … and there is time for each state to develop those policy prescriptions further, or not, as they expand coverage to all of the kids in their state.
So as Republicans look to abolish the ACA and come up with a plan of their own, and as Democrats debate how best to get to single-payer healthcare, it just seems obvious that both can and should adopt Medicare for All Kids as their bipartisan policy for the good of America’s future.
* Data from Kellogg Family Foundation studies.
** To be fair, Elizabeth Warren recently added Kid Coverage as an aspect of her broader and swift move toward Medicare for All, which I believe strengthens my case that it should be the focus of the next step.