The Children's Health Insurance Program was crafted in a period of
intense partisan and ideological controversy over health care
entitlements to provide "creditable coverage" for American children
below 200 percent of the Federal Poverty Level. This objective was
widely supported, though achieved only by a compromise between the
structural alternatives of a block grant, similar to the Maternal
and Child Health Block Grant or an entitlement resembling Medicaid.
According to David G. Smith, the CHIP compromise has been a
successful experiment that far exceeded expectations, both in
identifying and enrolling "targeted low-income children" and in
earning political capital. He argues that beyond this core mission,
the reauthorization of CHIPRA (Children's Health Insurance Program
Reauthorization Act of 2009) invites a larger mission: going beyond
enrollment of children to include assuring access, improving
quality, and containing costs of health care for them. Extending
this thrust, the author notes that CHIP could be used to establish
children's health as a niche--much like care for the
elderly--within the larger scheme of health care insurance for all.
Several areas of successful performance needed for the program
to be adjudged a success as well as its limitations are discussed
in the book. These areas include initial implementation, enrolling
kids, federal-state relations, and the uses and misuses of waivers
to modify the program. A description of changes made by the CHIPRA
reauthorization and the new Patient Protection Affordable Care Act
(PPACA) is also included. This is followed by a consideration of
lessons learned from CHIP's evolution and recommendations for
future development. In short, this is a valuable and readable
account for those interested in the current and future trends of
health care for the young.
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