January 23, 2002

President George W. Bush
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500

Dear Mr. President:

As you prepare for your State of the Union address, we urge you to apply the message that America should "leave no child behind" to children's health care just as you have applied it to children's education.

Good health and good health care are key ingredients to preparing children for learning. But eight and a half million children without health insurance are left behind today, denied adequate health care.(1) Their ear infections may go untreated. They may fall behind in vaccines that protect both them and their neighbors from deadly diseases. Instead of having preventive asthma medicine, they may end up in the emergency room at great cost to our society. Adolescents face new perils; without coverage for mental health and substance abuse, many will tragically never reach adulthood. There is no substitute for high-quality, consistent health care for children who are burdened with serious, chronic illness such as HIV-AIDS, cerebral palsy, mental retardation, spina bifida, and hemophilia.

Medicaid and the State Children's Health Insurance Program (SCHIP) cover millions of low- and moderate-income children, but they could cover far more. Our country's rising unemployment rate has led to a growing need for Medicaid and SCHIP coverage. This has put tremendous strain on state budgets. We urge you to include adequate funding in the budget to ensure that states can fund these programs to meet their residents' needs and expand outreach to ensure that all those eligible enroll. States should have the financial resources to increase access to these important health programs during a recession so that children can get needed health care and be ready to learn. The importance of health insurance coverage to children's readiness to learn is highlighted by a recent University of Texas study that found that health insurance coverage is associated with fewer absences from school.(2) In addition, states have found that health care spending on behalf of children is cost-effective. For instance, Texas is spending an estimated $1.7 billion on children's health over 10 years through SCHIP. The savings from lower spending for emergency room care, inpatient hospital stays, and immunizations are expected to be $3.0 billion, a net 10-year savings of $1.3 billion.(3)

The link between health care and education is clearly illustrated by states like California, which uses schools to enroll children in Medicaid and SCHIP. Schools are a natural partner in the effort to enroll families. The federal government needs to enhance its outreach efforts, including expanded school-based outreach, to increase enrollment of over 7 million children who are eligible for Medicaid or SCHIP but are not yet enrolled.(4) Consumers Union's West Coast Regional Office has successfully worked with schools and community-based organizations to develop and implement a variety of school-based enrollment programs.(5)

The need for affordable, comprehensive health insurance is not limited to children. There are about 40 million uninsured Americans and tens of millions of underinsured Americans. This is a tragedy for too many families; many end up bankrupt because of high medical bills. In addition, the failure of Medicare to provide coverage for prescription drugs and catastrophic illness also should be remedied.

Providing health care for children and others costs money. We urge you to provide adequate funds for health care by delaying tax cuts (both estate tax cuts and reductions in income tax rates for persons with high income) until we can ensure that no child is left behind.

Sincerely,

Gail Shearer
Director, Health Policy Analysis
Consumers Union Washington, DC Office

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(1) Health Insurance Coverage, 2000. U.S. Census Bureau, U.S. Department of Commerce.

(2) Kristine Lykens and Paul Jargowsky, Medicaid Matters: Children's Health and the Medicaid Eligibility (3) Expansion, forthcoming in Journal of Policy Analysis and Management, Volume 21, Number 2, Spring 2002.

(3) "Investment Budgeting" Potential Long-Term Impact, Senate Bill 445, Texas Legislative Budget Board, April 6, 1999.

(4) Donna Cohen Ross and Meg Booth, Center on Budget and Policy Priorities, Enrolling Children in Health Coverage Programs: Schools are Part of the Equation, October 2001.

(5) Healthy Kids Make Better Learners, A Guide to School-Based Enrollment in State-Sponsored Health Insurance Programs, Healthy Kids - Healthy Schools, West Coast Regional Office, Consumers Union, 2001.