Q&A: State Advocates Talk About Impact of Kids’ Health Coverage

At the start of 2020, five states plus the District of Columbia offered Cover All Kids. Since then, five more states have achieved legislative or budgetary victories for Cover All Kids to ensure health care is accessible to all children. Today we feature Voices for Health Justice advocates Rayna Hetlage from the Center for Health Progress in Colorado and Laura Waddell of New Jersey Citizen’s Action, along with advocate Rosana Ferraro of the Universal Health Care Foundation of Connecticut. They represent three of the five new states that have been successful in their Cover All Kids efforts and are entering the implementation phase.  

Waddell (NJ): When Cover All Kids legislation passed in 2021, it provided essential relief to New Jersey’s 90,000 uninsured children. The time to connect all children to coverage had never been greater, and the impact of COVID-19 further contributed to the urgency and importance of the bill passing. 

Hetlage (CO): Over the past few years, we have made huge strides in winning coverage expansion policies that cover undocumented immigrants. However, with the 2022 election on the horizon, we felt that we had a potentially shrinking window of opportunity to pass additional coverage expansion and wanted to push the Cover All Coloradans bill, which was passed into law earlier this year. Recent policy wins such as the Health Insurance Affordability Enterprise and the Colorado Option will expand coverage, but only have enough funding to cover about 10,000 people. 

Ferraro (CT): In 2019, the reported estimated uninsured rate for Connecticut children was 3.5%. However, we know that percentage is likely much higher when focusing on only undocumented children. One way to reduce the uninsured rate is to open eligibility to the HUSKY program, which includes Medicaid and CHIP in Connecticut to all who are income-eligible, regardless of immigration status.  

Waddell (NJ): We entered the pandemic with about 90,000 uninsured children, [including 18,000 who were undocumented]. Since the enactment of the Cover All Kids initiative, 37,659 of those uninsured children have been enrolled. 

Hetlage (CO): About 1,300 children are included in the Cover All Coloradans expansion. Additional children will receive coverage through the Colorado Option/Health Insurance Affordability Enterprise, but it is unclear how many of the 10,000 eligible will be children. 

Ferraro (CT): Expanding the HUSKY program for children ages 0-18 would significantly get more children covered. However, expanding HUSKY for all would cover 21,400 previously uninsured people including undocumented adults and children. 

Waddell (NJ): Cover All Kids received and continues to receive broad support from our partners and grassroots organizations and advocates. The fact that this effort will allow undocumented children to receive health coverage is what garners so much support. 

Hetlage (CO): We believe that the only way to make impactful change is through organized people or organized money and that we have to focus on community power building. Instead of mobilizing for short action, we have had increasing success in winning major policy fights by continuously improving the ways we center community decision making. In the Cover All Coloradans campaign, we created a steering committee made up of directly impacted members from our organization and the Colorado Immigrant Rights Coalition. The steering committee began meeting several months before the legislative session started and they were the final decision makers on the content of the bill. I cannot overstate how key this was to our success. There were many times when we received pushback on certain policy decisions because people thought it was just coming from some policy wonks. Once they learned that it was a decision by the people who are actually impacted, they were far more supportive.  

Ferraro (CT): By far the most effective strategy has been the creation of the HUSKY 4 Immigrants Coalition. Initially sparked by CT Students for a Dream, an immigrant-youth led organization fighting for immigrant justice, the HUSKY 4 Immigrants Coalition now includes over 20 organizations, with immigrant-led and immigrant-serving organizations at the center. Some effective strategies include engaging those most impacted and allies in public hearings and testimonies (either in-person, virtual or written), a week of action to mobilize supporters and providing interpretation so members could speak to their experience in their own language, whether testifying or talking with legislators 

Waddell (NJ): Now that the legislation has passed, the current focus is implementation. Looking ahead to 2023, we are planning for outreach and education efforts to begin. These efforts will inform income-eligible undocumented families that their children may enroll starting in January. We are currently working with the NJ Department of Human Services on a communication toolkit to prepare for this targeted outreach. Overall, the sentiment New Jersey partners feel with respect to implementation is that the work is not finished until every child is covered and can receive the healthcare they are entitled to. 

Hetlage (CO): We have evolved our policy and advocacy work over time to build toward the vision of our members setting and leading our policy agenda by organizing teams for each constituency that practice community-driven governance. In addition to our local campaigns, grassroots leaders from across our core constituencies who have identified a self-interest in state and federal policy work will join our cross-constituency policy team. This team of grassroots members will build off the structure developed for the Cover All Coloradans campaign in which directly impacted grassroots members came together as a steering committee to lead the strategic direction of the legislation.  

Ferraro (CT): We have been developing our legislative strategy for the upcoming year and doing one-on-ones with coalition organizations. Additionally, we will be leveraging cost, impact, opinion and messaging research to prepare coalition members for the upcoming session and briefing legislators on what we have learned. In January 2023, we will advocate for continued progress on coverage for those without documentation. This is a high-energy time, where we have the opportunity to ensure community members' stories and our demands are heard.