It's Time to Cover All Pennsylvania Kids: Dream Care

In 2006, Pennsylvania legislators promised families by passing “Cover All Kids” that every child in the state would have access to health care coverage through expanded access to its Children’s Health Insurance Program (CHIP). While this expansion has successfully increased the number of covered children in the state, 12 years later it still doesn’t “cover all kids.” In fact, it was never actually designed to do so. One short line in this legislation – just 13 words – specifically leaves out 38,000 of Pennsylvania’s most vulnerable children: those who are undocumented.

According to the law, all children can be enrolled in this type of coverage except those who do “not meet the citizenship requirements of Title XXI of the Social Security Act.”

This targeted exclusion has had very real consequences for children who were born outside of the United States and brought here by their families. According to Public Citizens for Children and Youth’s (PCCY) Dream Care campaign, which is working to achieve equitable access to CHIP for undocumented children, eight out of ten of these undocumented children haven’t been able to go to the doctor or receive significantly delayed care, and three-quarters of them cannot get the medications they need. As a pediatrician and contributor to the campaign, it’s disturbing to me that lawmakers would intentionally prevent an entire group of children from having the opportunity to receive adequate health care and grow into healthy, productive adults. Additionally, from a practical population health perspective, the harmful consequences that occur when undocumented (or any other) children face additional barriers to accessing basic care, such as vaccines, can also negatively impact the whole community.

Over the years, I’ve been involved with the Dream Care campaign as it’s grown to include more than 80 member organizations, including Children’s Hospital of Philadelphia, who are passionate about closing this gap in children’s health coverage. To us and to many others, the solution is clear; while undocumented immigrants are ineligible for federal insurance coverage, Pennsylvania can remove the 13 words from the current state law that excludes undocumented children and use state resources to include them. A handful of other states have already taken this more inclusive approach, and Pennsylvania can certainly join the ranks of leaders in this space.

This move would both achieve the state’s declared vision for children’s health, and I believe, be a cost-effective investment. As one of my former PolicyLab colleagues previously explained, the cost for covering these children would be less than one percent of the state budget. (Recent estimates actually put that cost at around .05 percent of the state budget.) Without options for health insurance, children are forced to rely on emergency care, which can be expensive and drive up uncompensated care costs for taxpayers.

Improving access to care to this vulnerable population of children is perhaps more important now than it has ever been. In recent months, we have witnessed a troubling rise in the number of immigrant families, both lawfully in the U.S. and undocumented, who report toxic stress and anxiety due to the many proposed changes to immigration policies and enforcement practices. Pediatricians and parents have reported that this additional stress has led a number of problematic side effects for these children, including problems sleeping, headaches, stomachaches, depression and anxiety.  Guaranteed access to care could mitigate these adverse consequences.

Pennsylvania, the birth place of CHIP, has an opportunity once again to lead the charge on improving children’s health care and coverage. This is the time to ensure that no Pennsylvania kid is left without the opportunity to have a safe and healthy childhood.