An Interview with

An interview on the Internet-based resource for young physicians called

May 2001

Question for Grace-Marie Arnett, President, Galen Institute:

What is the best way to provide health coverage for uninsured children?

And the reply:

It is important for children to have access to the health care that they need, but it is equally important for their parents to be covered. Right now, the system is structured to divide parents and children and to keep them from having the continuity of family coverage that is best for everyone.

We would all be better served by a system that allowed families to own and control their own health coverage so they can make the health care arrangements and choose the doctors and health plans that best suit their unique needs.

The new State Children’s Health Insurance Program (SCHIP) was designed to provide coverage for uninsured children through a variety of state programs. Unfortunately, the Clinton administration was reluctant to approve any programs that didn’t involve an expansion of Medicaid, the health program for the poor.

While Medicaid’s benefit package is very generous, payments to doctors are abysmally low in most states, and many doctors lose money when they treat Medicaid patients. In addition, the process of qualifying for Medicaid/SCHIP can be cumbersome and paperwork-intensive, putting an extra burden on already busy parents. Finally, having children on one health plan and parents on another – or worse, without any coverage – divides families.

There is a better way. Congress intended for states to be able to use SCHIP money to provide tax credits so children could have access to private health insurance. That could mean extra money for parents to add their children to the health plans that they receive at work. And if parents are able to get coverage for the whole family for the cost of coverage all of their children, then the whole family could be covered.

The Bush administration has an opportunity to open the range of options available under the existing SCHIP law to give states more freedom to provide the SCHIP subsidy through tax credits.

The current Congress has an opportunity to provide a sensible new set of incentives and subsidies for hard working parents and their children through refundable tax credits that give them the financial support they need to obtain private health insurance. The market for individually-purchased health insurance provides attractive options for affordable health insurance in many states, and the boost of providing tax credits for the uninsured could add millions of children and their parents to the ranks of the insured.

The idea of refundable tax credits has the support of the leadership in Congress and the White House. And the American Medical Association is a strong supporter of individually-based tax credits as an important step in restoring control over health care decisions to physicians and their patients.

The time is now.

To read more, see the Galen Institute’s website, and read in the Library about Access to Private Health Insurance.


Grace-Marie Arnett is president of the Galen Institute, a not-for-profit health policy research organization in Alexandria, VA. She edited Empowering Health Care Consumers through Tax Reform, University of Michigan Press, 1999. She can be reached at

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