Possibly. NC Health Choice is a government-run, tax-paid health insurance program for children in families earning up to 200 percent of the federal poverty level (FPL). Legislation proposed in the House Budget for biennium 2008-2009 would create a $10 million-plus NC Kids’ Care program that would expand coverage to some 12,000 more children of families earning up to 300 percent of the poverty limit. That means families earning as much as $61,950 for a family of four – an income level that includes half of all families in North Carolina – would be eligible for state-subsidized insurance.
If the state wanted to turn NC Health Choice into a universal child health insurance program, it would have to take three steps. First, it would have to remove the income cap and make all children eligible, regardless of how much their parents earn. NC Kids’ Care gets us halfway there.
Some states already apply higher income caps. Maryland, for example, has a program, similar to NC Kids Care, that employs an income cap of 300 percent of FPL. Similarly, Connecticut sets its income cap so high that half of all households in the state are eligible for taxpayer-subsidized insurance for kids. In short, the higher the income cap, the more children will enroll.
The second step toward making NC Health Choice a universal program would be to eliminate the application process. Today the statutory processing time for an application is 45 days. In turn, children eligible for NC Health Choice are enrolled one year at a time. If the application wait time, or the reenrollment process, were eliminated, more children would enroll in the program.
As part of eliminating the application process, the state would also have to eliminate the enrollment cap. Today NC Health Choice limits the number of children who can enroll based on a pre-set budget. With universal coverage, the state would no longer be able to limit enrollment numbers. As a result, however, the General Assembly would have much less control over spending for the program.
A final dimension to consider is coverage. In order to make universal coverage feasible, the state would ultimately have to make enrollment mandatory for all children. This would be tantamount to outlawing private insurance plans for children. Such models have traditionally been used in parts of Europe and are also currently in place in Canada. Likewise, President Bill Clinton’s 1994 Health Security Act proposed criminalizing private healthcare.