Pulse on Policy

CHIP-ing away at Health Care Coverage for Children


If funding for the Children’s Health Insurance Program (CHIP) is not extended by Congress this month, millions of children in the United States will be at risk of losing their health insurance coverage in just six months. Currently, 8.9 million children throughout the United States and between 60,000 and 70,000 children in Missouri have coverage through CHIP.

In 1997, CHIP was enacted by Congress with strong bipartisan support in order to provide health insurance coverage for children who were neither eligible for Medicaid nor employer-based insurance. At the time of CHIP’s enactment, 23% of low-income children living at or below 200% of the Federal Poverty Level lacked insurance coverage. Since then, the percentage of uninsured children has plunged to 4.8%, both nationally and statewide, largely due to expansions in Medicaid and CHIP.

CHIP is a high-impact and cost-effective program. By promoting preventive services and primary care, CHIP has improved access to quality health care while simultaneously lowering costs for hospitals. Between 2000 and 2014, costly preventable hospitalizations for CHIP enrollees decreased by 28.9%, while emergency room visits decreased by 13.2%.

Public insurance programs such as CHIP play a critical role in addressing health, socioeconomic, racial, and geographic disparities. CHIP and Medicaid provide coverage to over 44% of children with special health care needs and disabilities. In rural areas, 77.1% of low-income children rely on public insurance coverage. Nationally, more than half of Black children (56%) and Hispanic children (52%) participate in public insurance programs.

In order to maintain hard-won gains in children’s health insurance coverage and the current near-universal insurance rate, Congress needs to reauthorize CHIP prior to its expiration on September 30, 2017. Gary Parker, director of the ClarkFox Policy Institute, stated, “Allowing CHIP to lapse would put the children of working families at risk while creating undue financial hardship for families across the state and country. Furthermore, the last 20 years of progress in increasing access to healthcare for children through CHIP would be effectively negated.”


From budget cuts to baby wipes: will teen pregnancy be back on the rise?


The Trump Administration has eliminated over $213 million in funds for teen pregnancy prevention programs and research, raising concerns that teen pregnancy rates will begin to rise.

The Teen Pregnancy Prevention Program (TPPP) was established by the Obama Administration in 2010 to promote evidence-based interventions for reducing teen pregnancy rates among young people at higher risk. Administered by the U.S. Department of Health and Human Services Office of Adolescent Health, these programs were intended to serve over 1 million youth during the second five-year cycle of funding. Similar programs have successfully resulted in a decrease in teen pregnancy rates and sexually transmitted infections. However, at least 81 of the 86 programs and institutions that were funded were informed that their funding will be cut.

The Big Picture

The United States continues to have one of the highest teen birth rates among developed countries. Furthermore, 77% of teen pregnancies are unplanned. The birth rate among adolescents between the ages of 15 and 19 in St. Louis City is nearly twice as high as the national average.

In addition to these immediate costs, there are long-term consequences to the economy. Teen pregnancy can interrupt educational achievement and limit young parents to low-wage employment. Furthermore, the children of teenage mothers are more likely to drop out of high school. They experience greater health challenges, higher incarceration rates and unemployment, and continue the cycle of adolescent parenting.

The cost of teen childbearing in the United States was at least $9.4 billion in 2010. In the same year, the cost of teen childbearing in Missouri was $184 million.

Rates of teen pregnancy have reached a significant decline, with a 51% decrease in teen pregnancy between 1990 and 2010. These rates continue to decline, with an 8% decrease nationally between 2014 and 2015. In Missouri, the teen birth rate has declined 61% between 1991 and 2015.

Regional Impacts

Better Family Life, a St. Louis-based non-profit that promotes positive and innovative changes in the lives of individuals and their families, has been a recipient of this funding. Better Family Life has been a designated TPPP grantee since 2010, and is currently serving 2,000 middle and high school students in partnership with local schools. Using evidence-based models, teen-friendly strategies, and trauma-informed approaches, Better Family Life aims to reduce disparities in teen pregnancy and STIs among adolescents facing multiple social challenges.

“We are at a historic low in teen pregnancy, representing the culmination of decades of work to address this complex issue using a multi-pronged approach,” said Lorien Carter, associate professor of practice at the Brown School at Washington University. Carter is also an executive board member of the Teen Pregnancy and Prevention Partnership, a sub-grantee of Better Family Life.

“The implementation of these programs represents the first time that federal attention was shifted to using existing research in order to implement medically accurate, evidence-based reproductive health curricula,” she said. “If we don’t maintain this level of attention to using what evidence proves to be effective, rates will go back up.”