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1 Janet Currie, “Healthy Wealthy, and Wise: Socioeconomic Status, Poor Health in Childhood, and Human Capital Development,” Journal of Economic Literature, March 2009.

ealth care costs have continued to spiral in this decade. Nationwide, the average annual premium for family coverage in employer- sponsored health insurance plans more than doubled, from just under

$6,000 per year in 1999 to nearly $14,000 in 2009.

Rising costs contributed to the further erosion of employment-based cover-

age for both workers and their dependents.

In many states, however, this long-term trend was offset by the expansion of public health insurance coverage for children through Medicaid and the Children’s Health Insurance Program (CHIP).

Illinois Children Fare Better Illinois children have recently fared better than national averages on health insurance coverage. In 2007-08, 6.5 percent of Illinois children lacked health insurance coverage, well below the 10.4 percent U.S. average. e Illinois figure was a considerable improvement over the rates just three years prior, when 10.4 percent of Illinois children were uninsured, about the same as the nationwide rate.

Low-income children are more likely to be uninsured, however, even though they too have seen improvements. In 2004-05, 17.6 percent of low-income children in Illinois

were uninsured, slightly above the nation- wide rate. By 2007-08, the uninsured rate would drop to 11.5 percent in Illinois, considerably lower than the U.S. average of 16.2 percent.

Improvements in health insurance coverage have been particularly striking for Latino and African-American children. e share of Latino children without health coverage was cut in half, from 22 percent in 2002-03 to 10 percent in 2007-08. Likewise, the uninsured rate for African-American chil- dren declined from a high of 17 percent in 2005-06 to 10 percent in the most recently available data.

State Programs Cover More Children

ese encouraging trends in health insur- ance for Illinois children reflect the impact of expanded coverage through Medicaid, CHIP, and the state-funded “All Kids” program.

All Kids offers coverage for uninsured children regardless of family income, health status, or citizenship status. Families are responsible for monthly premiums and copayments on a slid- ing scale based on household income.

In June 2009, about 70,000 children were enrolled in All Kids expansion. In addition, All Kids outreach efforts and a unified appli- cation process have had positive spillover effects on enrollment in Medicaid and CHIP.

Between June 2006 and June 2009, 300,000 more children were enrolled in Medicaid, while CHIP enrollment rose about 56,000.

Since the implementation of All Kids, the number of children covered under state programs has increased from 1.2 million to more than 1.6 million.

e impact of All Kids is reflected across Illinois. Between state fiscal year 2006 and 2008, enrollment of children in medical

assistance programs increased 20 percent statewide and more than 40 percent in five collar counties in the Chicago region:

Dupage, Kane, Lake, McHenry, and Will.

Challenges Remain

Despite the remarkable progress in health care coverage for Illinois children, signifi- cant challenges remain. e proportion of uninsured children in Illinois is still higher than in neighboring Indiana, Iowa, Michigan, and Wisconsin. Moreover, in Illinois as well as other states, gaps are wide between cov- erage for children and coverage for parents.

In 2007-08, 12.5 percent of Illinois parents lacked health insurance coverage, nearly twice the rate for children.

Lack of health insurance and rising health care costs for parents are major strains on family budgets. Parents’ economic circum- stances affect the health of children, especially at early ages. Moreover, factors such as fetal health, birth weight, nutrition, mental health, and chronic physical condi- tions are linked to longer-term educational and economic outcomes in adulthood.1

e number of children covered under

state programs has increased from

1.2 million to more than 1.6 million.

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Health

Average Annual Premiums for Family Coverage in Employer-Sponsored Health Insurance Plans

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

Employee contribution Employer cost

2009 2008

2007 2006

2005 2004

2003 2002

2001 2000

1999

$1,543 $1,619 $1,787 $2,137

$2,412 $2,661

$2,713 $2,973 $3,281 $3,354 $3,515

$4,248 $4,819 $5,274 $5,866 $6,656 $7,289 $8,167 $8,507 $8,825 $9,326 $9,860

Source: Kaiser Family Foundation and Health Research & Educational Trust

Health Insurance Coverage by Age Group in Illinois, 2008

Under Age 18

Ages

18-64 Age 65+

Private insurance 67.8% 73.6% 68.8%

Public insurance 32.6% 12.1% 92.6%

Uninsured 6.4% 17.4% 1.4%

Note: Individuals may be covered by more than one type of insurance.

Source: U.S. Census Bureau, Current Population Survey

Adults and Children with Employer-Sponsored Health Insurance in Illinois

50%

55%

60%

65%

70%

75%

2007-2008 2003-2004

1999-2000

Children Non-elderly adults

72.4%

69.7%

67.7%

69.4%

66.5%

65.1%

Source: U.S. Bureau of the Census, Current Population Survey

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Low-Income Children without Health Insurance, Illinois and U.S., Two Year Moving Averages

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

U.S. total Illinois

2 2006-07 2005-06

2004-05 2003-04

2002-03

18.2% 18.3% 17.9% 17.6% 17.9%

13.8%

17.7%

1 16.9%

17.3% 17.1%

Source: U.S. Census Bureau, Current Population Survey

0%

2%

4%

6%

8%

10%

12%

U.S. Total Illinois

2

12.1%

11.5% 11.3% 11.1% 10.8% 10.7%

10.6% 10.1% 10.5% 10.2% 10.1% 10.4%

11.3% 11.4%

10.4%

9.8%

8.1%

6.5%

Children without Health Insurance, Illinois and U.S., Two-Year Moving Averages

0%

2%

4%

6%

8%

10%

12%

U.S. Total Illinois

2004-05 2003-04

2002-03 2001-02

2000-01 1999-00

12.1%

11.5% 11.3% 11.1% 10.8% 10.7%

10.6% 10.1% 10.5% 10.2% 10.1% 10.4%

2007-08 2006-07

2005-06

11.3% 11.4%

10.4%

9.8%

8.1%

6.5%

Source: U.S. Census Bureau, Current Population Survey

Uninsured Children by Poverty Status in Illinois and U.S., 2006-2008

Illinois U.S. Total

< 100% FPL 14% 17%

100-199% FPL 13 16

200-249% FPL 5 13

250% FPL & above 4 6

FPL = federal poverty level

Source: Annie E. Casey Foundation, KIDS COUNT Data Center (based on data from U.S. Bureau of the Census, Current Population Survey)

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Uninsured Children and Parents, Midwestern States, 2007-2008

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Parents Children

U.S. total Wisconsin

Ohio Missouri

Minnesota Michigan

Iowa Indiana

Illinois

6.5%

12.5%

5.6%

5.0%

5.5%

11.8%

6.5%

8.8% 8.6%

7.2%

10.9%

5.8%

8.1%

10.4%

16.7%

13.1%

9.3%

15.6%

Source: U.S. Census Bureau and Kaiser Family Foundation

Health

Children without Health Insurance by Race-Ethnicity in Illinois, Two-Year Moving Averages

0%

5%

10%

15%

20%

25%

Latino Black

White

2007-08 2006-07

2005-06 2004-05

2003-04 2002-03

21.9%

19.2%

16.6%

14.6%

12.6%

10.2%

15.5%

17.0% 17.3%

13.2%

10.0%

6.0% 5.8% 6.4% 6.2%

5.1% 4.3%

13.7%

Source: U.S. Census Bureau, Current Population Survey

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Children's Enrollment in Public Health Insurance Programs in Illinois* (in 1,000s)

0 200 400 600 800 1,000 1,200 1,400 1,600 1,800

All Kids expansion CHIP

Medicaid

2009 2008

2007 2006

2005 2004

2003 2002

2001 2000

1,015

1,160 1,215

1,420

1,651 1,521

864 938 940

1,083

* As of June of each year

Source: Illinois Department of Healthcare and Family Services

Percentage of Illinois Mothers Beginning Prenatal Care in the First Trimester

2000 2001 2002 2003 2004 2005 2006

White 90% 90% 91% 91% 91% 91% 91%

Black 71% 73% 74% 74% 74% 76% 77%

Latina 73% 77% 78% 80% 80% 82% 83%

Source: National Center for Health Statistics

Enrollment of Children from Six-County Chicago Region in Medical Assistance Programs*

FY 2006 (1,000s)

FY 2007 (1,000s)

FY 2008 (1,000s)

Change 2006-2008

(1,000s)

Pct. change 2006-2008

Cook 649.8 717.1 753.8 103.9 16%

DuPage 40.3 51.8 59.4 19.1 48

Kane 46.5 59.5 67.3 20.8 45

Lake 40.1 51.5 57.3 17.1 43

McHenry 11.5 14.5 16.8 5.3 46

Will 34.2 42.9 49.1 14.9 44

Six-county total 822.4 937.3 1,003.6 181.2 22

Rest of state 387.9 427.6 452.3 64.3 17

Statewide 1,210.3 1,364.9 1,455.8 245.5 20

• Enrollment as of the last day of each fiscal year

Source: Illinois Department of Healthcare and Family Services

Medical Assistance Programs, Shares of Enrollment and Spending, FY 2007

Enrollment Spending

Chldren 60% 28%

Nondisabled adults 22 18

Adults with disabilities 11 34

Seniors 7 20

Source: Illinois Department of Healthcare and Family Services

Data reflect spending from DHFS General Revenue Fund and related funds.

(in 1,000s)

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Health

Children's Access to Care

by Health Insurance Status, 2008

Private Insurance

Public

Insurance Uninsured

No usual source of care 3% 4% 30%

Postponed seeking care due to cost* 3% 4% 20%

Went without needed care due to cost* 1% 2% 14%

Last physician contact more than 2 years ago 2% 3% 16%

Unmet dental need due to cost 4% 6% 28%

Last dental visit more than 2 years ago 12% 17% 34%

* In past 12 months

Source: Kaiser Family Foundation, based on data from National Health Interview Survey

Illinois Adults Reporting Eight or More Days per Month of Physical or Mental Health Problems, 2006-2007

Income level Physical

Health

Mental Health

< $15,000 28.2% 21.7%

$15,000-34,999 16.1% 13.7%

$35,000-49,999 12.7% 12.3%

> $50,000 7.4% 9.7%

Source: Illinois Department of Public Health, Behavioral Risk Factor Surveillance System (BRFSS)

Substantiated Cases of Child of Abuse and Neglect in Illinois

0 10 20 30 40 50 60

2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995

53.2

44.5 41.8

33.8 32.7

28.9 29.8 29.8

36.9

26.8 27.0 26.8 27.4 26.5 28.4

Source: Illinois Department of Children and Family Services

Poverty Status and Health Status of Children in Illinois, 2006-2008

Below 100% FPL

100% to 199% FPL

200% FPL

& above Reported health status

Excellent 35.6% 38.7% 54.5%

Very good 31.1 36.1 31.5

Good 29.9 22.9 13.1

Fair or poor 3.4 2.3 1.0

FPL = federal poverty level

Source: U.S. Census Bureau, Current Population Survey

(in 1,000s)

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oday’s economic struggles only add to the already complex challenges of the most vul- nerable populations. Poverty by far is the most difficult factor to alter and has the most far-reaching effect on the lives of the families we serve. In the past two years, the economy’s slide has dramatically increased family stress and the need for services and supports for families with young children at risk for abuse or neglect.

Family Supports During Crisis Safe Families Illinois and Crisis Nurseries are two programs that the Illinois Department of Children and Family Services (IDCFS) specifically designed to meet the needs of parents in crisis. In 2007, the Safe Families program placed approximately 200 children in temporary families (with an average stay of 44 days) to allow their parents to secure adequate housing and economic resources to stabilize and maintain a home for them- selves and their children. Current trends indicate the program will have placed 1,000 children in 2009. Similar increases are evi-

dent in the use of Crisis Nurseries. In fact, families are being turned away at Crisis Nurseries for lack of capacity. These vol- untary programs are a telling barometer of the future need for mandated child welfare services.

Collaboration Expands Reach It is the responsibility of the child welfare system to meet the emerging needs of its population. To do so, we must remain vigi- lant in adjusting our services to meet these new needs. rough important collabora- tions with other agencies, IDCFS is redefining and expanding its ability to respond in tan- gible ways to family need. Strengthening Families Illinois, Family Advocacy Centers, and Differential Response are three initia- tives to address limited resources while expanding capacity.

New Prevention and Support Strategies

In 2006, IDCFS integrated Strengthening Families Illinois into a statewide initiative promoting a research-informed, child abuse

prevention strategy. e prevention strategy works through early care and education pro- grams, child welfare collaboration, and through parents directly. is multipronged strategy, research shows, significantly reduces incidences of abuse and neglect in families and keeps them strong by embedding several protective factors into the daily practice of IDCFS.

Beginning in 2004, Family Advocacy Centers were established statewide to advocate on

behalf of parents and support them in moving toward family reunification. ey also advocated on behalf of parents facing challenges in maintaining and stabilizing their families. Parents participate voluntar- ily and receive the necessary supports and

resources to create safe, secure, and nurtur- ing environments in which their children and families can learn, grow, and thrive.

In August 2009, Illinois signed the Differ- ential Response Program Act into law. is act allows IDCFS to establish another path- way at the point of initial investigation for families at low risk for child abuse or neglect.

Rather than opening a formal investigation, the department refers families facing eco- nomic stress to community-based services.

In working with our sister agencies, the department is maximizing resources and reducing duplication. Our efforts will lead to a more coordinated system and services that are more easily accessible.

is coordination and access will lead to improved overall well-being and better func- tioning families and communities.

By Erwin McEwen

Acting Director, Illinois Department of Children and Family Services

T

rough important collaborations

with other agencies, IDCFS is

redefining and expanding its ability

to respond to family need.

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ealth and economic security go hand in hand. Although most of the nation’s atten- tion now is focused on health care reform, health insurance does not guarantee health.

A 2002 Health Affairs article by Michael McGinnis and coauthors finds that lack of medical care accounts for only 10 percent of the contributors to early death, while social circumstances, personal behaviors, and envi- ronmental conditions explained 60 percent of premature deaths.

The Link Between Income and Health

Income is perhaps the clearest social factor that influences health. In a survey of Illinois adults, those with incomes below $15,000 were more than four times as likely as those with incomes above $50,000 to report that their poor physical or mental health kept them from doing their usual activities eight or more days in the prior month. One of these activities was likely work. Children in

poverty also tend to be in poorer health than other children, which no doubt affects the absenteeism of working parents. Moreover, evidence suggests that child health affects a child’s future socioeconomic status.1 McGinnis estimates that poverty is responsi- ble for 6 percent of U.S. mortality, and research has demonstrated that lower-income groups face a greater risk of dying prematurely as inequality (the gap between rich and poor) increases. Nationally,

those at the lowest rung of the economic ladder (making less than $10,000 per year) are three times

more likely to die prematurely (before age 65) than those at the highest rung. Even those making between $20,000 and $29,000 are twice as likely to die prematurely than those with the highest incomes.2Similar dispari- ties are evident by education level. For

adults between ages 45 and 64, those with the highest level of education are 2.5 times less likely to die in any given year than those with the lowest levels of education.

Healthier Employees Equal Savings

Employers have quickly realized the impact of poor health on their workforce. e Wellness Council of America finds that every dollar spent on comprehensive employee

wellness programs saves the company up to three dollars in health care costs. Wellness programs have also been shown to improve employee productivity, reduce absenteeism, and reduce employee turnover. Health insurance is important to a business’s bottom

line, but businesses are learning that health insurance is not enough to guarantee the healthy workforce they need to succeed.

New Directions for Public Health Programs

Public health practitioners have embraced this idea of “social determinants” of health.

We have recognized that to improve health, particularly among the most vulnerable groups, the public health mission must include a focus on education, poverty, hous- ing, social cohesion, and other social issues.

is will take a concerted effort to broaden the definitions of both health and economic security, and to forge partnerships that align the goals, activities, and policy prescriptions of the health and social justice communities.

If we are to make strides in improving family economic security, it is critical that we also attend to the relationship between the health of struggling families and the ability to work productively and provide for the security of their families.

Health Disparities and Work

By Elissa Bassler

CEO, Illinois Public Health Institute

H

1Janet Currie, “Child Health and the Intergenerational Transmission of Human Capital,” VOX, July 19, 2008, available at oxeu.org.

2Nancy Adler et al., “Reaching for a Healthier Life” (Chicago: MacArthur Research Network on Socioeconomic Status and Health, n.d.).

e public health mission must include

a focus on education, poverty, housing,

social cohesion, and other social issues.

References

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