Children's Healthcare: Stronger Federal Standards Needed

A new state-by-state score card shows great variation in the care kids receive.

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Making sure kids have good healthcare is something everybody agrees is important, but a new report shows that some states do a much better job than others of making good on that intention. Aiming to cover more of the roughly 9 million children who lack insurance, both Democratic presidential candidates have called for universal coverage for children. Without a stronger commitment at the federal level, it's hard to imagine how we're ever going to address the inequities highlighted by the report so that kids can count on getting the care they need no matter where they live.

Organized as a score card, the Commonwealth Fund report examined how states perform on 13 different indicators in five categories: access to care, quality of care, cost, potential to lead healthy and productive lives, and equity in the quality of care provided regardless of race, income, or insurance status. It ranked states within each category and then assigned states a final overall ranking.

In general, states in the northeastern and north central parts of the country got higher marks on access to and quality of care, while many western and southern states had lower costs. Iowa, the No. 1 state overall, was ranked second in both the access and quality categories, for example. Fourth-ranked Massachusetts had the best record of all states on ensuring that kids got five key vaccinations as well as preventive medical and dental care visits. You can check out this interactive map for state-by-state details.

There were some head scratchers: Why did reform-minded Oregon perform so poorly, coming in No. 43 overall? What's behind Wyoming's top mark for making sure that kids get the mental-health care they need?

The rankings may already be somewhat out of date. Illinois, for example, recently launched a program to provide universal coverage for all its children; its 35th-place finish in the category that measures access to care may have improved. Rhode Island, on the other hand, which was in third place for healthcare access, earlier this year cut more than 2,800 immigrant children from its RIte Care program as the state struggled to close a budget deficit.

But the specific details of each state's performance are less important than the overall message that the healthcare America is giving its children is extremely inconsistent. The rankings in the report may encourage some states to take a harder look at what they can do to improve their performance. That's great. But clearly there's a need for a larger federal role in setting minimum standards to encourage better coverage and care for children.

Instead, the State Children's Health Insurance Program, which gives federal funds to the states and through which millions of low-income kids receive healthcare, has become a political football, with President Bush and Congress sparring over income eligibility standards. With the extension of the program until March 2009, a decision on its long-term direction has been postponed rather than resolved.

"We need to get beyond the ever shifting politics when it comes to covering kids and making sure they have access to care," says Cindy Mann, executive director of the Center for Children and Families at Georgetown University's Health Policy Institute. "It can't be, 'Is it popular today?' or 'Is it in vogue today?' It's a critical value."