Putting Children’s Insurance First

The state budget crisis has not been easy. Faced with large deficits, state officials have had to make tough choices about important programs. Yet there are some state services too vital to fall victim to budget politics. The Children’s Medical Security Plan (CMSP) and the MassHealth program, which provide low-cost health insurance to poor and middle-income working families, deserve to be spared.

These two healthcare programs offer low monthly premiums for quality health benefits to families that would otherwise likely live uninsured. Over the last two years, however, the state has already cut services and instituted an enrollment cap on CMSP. In February, more than 10,000 children were waiting for health insurance and that number continues to grow. But this was not enough. Facing another year of inadequate funding, state administrators prepared to change CMSP and MassHealth once again.

State officials had a number of options, from cutting services again to lowering the enrollment cap. Representatives of the medical community advised an approach that cut costs while minimizing hardship on children and encouraging families to remain insured. They argued that policies which pushed parents away from state insurance programs meant children would not get necessary services and those with urgent healthcare needs would be forced to rely on the emergency room as their primary care provider—a dangerous and expensive proposition. Of all the options available to state administrators, raising premiums was the most likely to push families away from the program. But in November 2003 that is exactly what the state did.

The worst premium increases fell on families with incomes from 200 percent to 400 percent of the federal poverty level. These families now pay nearly five times as much for health insurance. Working poor families—earning anywhere from 134 percent to 150 percent of the federal poverty level—had paid no premiums before November, 2003. After the premium increase, they found themselves forced to pay $12 for every child enrolled in the program. These increases fall on families already struggling in the face of cuts to other social services and an economy that has left wages stagnant.

Fortunately, activists including members of the Harvard community are fighting the premium hikes. The Children’s Health Access Coalition (CHAC) has been working to reverse the cuts to state health insurance programs and they have had help from an innovative campus community service group called Project Health.

When the premium increases went into effect, Project Health, which conducts a community service program out of Boston Medical Center, began asking its clients how the increased premiums and other changes to the state insurance programs were affecting their lives. The stories Project Health dug up, along with the CHAC’s activism, convinced state administrators to place a family cap on premiums, so families with multiple children enrolled in state health insurance programs won’t be forced to pay excessively high monthly fees. Project HEALTH is now working to collect statistics on the effect of the premium increases. They hope to use the information they collect to lobby the legislature for increased health insurance funding.

We are proud that Harvard students are part of the solution to this problem. The Harvard College Democrats have already offered to help CHAC, and Project HEALTH is continuing and expanding its work. Other campus groups that care about public health should join these students to help roll back all the premium increases, because the state should not fill the budget gap by sacrificing the health of Massachusetts’ kids. The state is in fiscal crisis, but we are confident that, with the right priorities, children’s health insurance can be saved.