As the pace of health reform movement at the federal level slowed down over the past week, action in the states heated up. Since my job entails work on federal and state policy, this resulted in a pivot from a focus on federal health reform 24-7 to an intense effort to get a handle on state actions, in particular important budget decisions being made that will impact children’s health care. The one glimmer of hope for some downtime in July now has been dashed.

I have been joking with my kids that they are part of my health policy team because they have indirectly supported my work by giving up significant Mom time on nights/weekends when I have to read large pieces of federal or state legislation to decipher the impact on children’s health care and directly by posing for pictures for my blogs and participating in my video testimonial for the Speak Now for Children campaign. They tell me I owe them big!

Putting aside what I owe my kids (that is a topic for another blog), recent actions demonstrate the immense challenges states are facing in the provision of health coverage and brings up the question of whether the current system is sustainable in the long-term? I think the experiences in the states shows the need for health reform that ensures that all children have comprehensive and affordable coverage that provides the services they need when they need them. Without national reform, the variations among states in children’s eligibility for public health insurance programs will get worse and without a new federal investment many children who currently are enrolled in these programs may lose their coverage or access to the services they need when they need them.

Last week, I attended the National Conference of State Legislatures Legislative Summit and a major topic of conversation was health reform and the impact on the states.  States are under a lot of pressure right now due to the economic recession and many of them have had to make major cuts in their state budgets to stay afloat. Unlike the federal government, states for the most part cannot run deficits – their budgets must be balanced. One of the largest items in state budgets is Medicaid, which provides health care to millions of children across the country. Because it is such a big part of state budgets, Medicaid is often on the chopping block. Other states have also had to make cuts to their Children’s Health Insurance Program (CHIP), which provides insurance to children with working parents who do not qualify for Medicaid, but do not get health insurance through their employer.

One recent example in California demonstrates what the need to fill significant budget holes can mean for children’s health care. California had a $26 billion budget shortfall which necessitates severe budget cuts. The state is cutting over $170 million from the state’s CHIP program, which will at least result in a waiting list for coverage and could result in lowering the eligibility level for children, and over $1 billion from the state’s Medicaid program. These cuts will definitely impact children’s coverage and their ability to access needed health care services.

Although the magnitude of the problem is certainly larger in California, many states across the country are returning to earlier passed budgets to make further cuts, many in the health care area, to fill budget shortfalls. The National Association of State Budget Directors says that the fiscal condition for almost every state deteriorated in fiscal year 2009 and this decline is expected to continue in fiscal years 2010, 2011 and 2012.

Now would be a great time for all of us to share our stories about health care and how the decisions in our states affects our children, but also millions of children across the country. www.Speaknowforkids.org