SCHIP: Access Does Not Equal Quality
Written by Ardena L. Flippin, MD, MBA   
 Dr. Ardena Flippin

A Republican President vetoed a bill initiated by a bipartisan Senate compromise and propelled by Republican effort to provide health insurance to 10 million low-income uninsured children.

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Is this a bad thing? I think so. In a time when citizens are calling for health care reform, traditional polar opposites have sent a message that they will work together to perpetuate and enhance healthcare for children. Now is not the time to object to SCHIP reauthorization based on cost when we are pouring hundreds of billions of dollars into the Iraq war. This is not to say that SCHIP is not entirely without its obstacles.

One of Mr. Bush’s reasons for the veto was mistakenly thinking (or being advised) that the proposal would “cause huge increases in government spending”…[and lead to] “government-run-health care for every American.” (The New York Times, November 5, 2007).

There can be no doubt that to provide increased health insurance coverage for children can work to reduce preventable morbidity and health disparities that exist, and (possibly) increase cost savings. One would hope that passing SCHIP would also supposedly relieve the burden on the traditional “safety net”, emergency rooms and preventable .

According to a January 2007 Kaiser Family Foundation report, there are significant SCHIP findings:

  • SCHIP, with Medicaid, helped to reduce the number of low-income uninsured children, but many children remain uninsured.
  • States increased outreach and eligibility simplification efforts for both Medicaid and SCHIP to expand coverage; however, state fiscal pressures and new citizenship and identity documentation requirements run counter to these efforts.
  • Through waivers, SCHIP covers some pregnant women and parents, but coverage beyond these groups has been controversial.
  • Coverage through Medicaid and SCHIP increases access to care; however, compared to Medicaid, separate SCHIP programs have fewer benefits and additional cost sharing which can create some barriers to needed care.
  • Capped financing in SCHIP helped to limit federal spending, but there has been a mismatch in the amount of aggregate funding available and in the distribution of funds across states.

The popular notion is that SCHIP involves solely an issue of access. If reauthorized, SCHIP (and Medicaid) would be monitored by a set of quality pediatric-care measures formulated by the Department of Health and Human Services. These measures ideally would apply to primary care, preventative, physical, behavioral and reproductive concerns, to name a few.

A recent large study in the New England Journal of medicine (October 11, 2007) found that only 46 percent of America’s children received appropriate medical care when they visit health professionals, and most of the youngsters in the study were white, middle-class and had health insurance. Access does not equal quality.

My concern is whether the parts of the health care system that will be affected are prepared for what will be a very large impact to the delivery of pediatric/adolescent services.

Mr. Bush may have done the almost-right thing, and for the wrong reason.


New York Times. Missteps on Both Sides Led to Health Bill Veto. November 5, 2007.

New England Journal of Medicine. October 11, 2007.

The Kaiser Commission on Medicaid and the Uninsured. A Decade of SCHIP Experience and Issues for Reauthorization. January 2007.

About the Author

Dr. Flippin brings a wealth of experience, starting with her long tenure as an attending physician at the Cook County hospital Emergency Department. She is currently Corporate Compliance and HIPAA Privacy Officer at major Chicago hospital.

Discuss this article on the forums. (6 posts)

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