espite the fact that nearly a third of all uninsured children will continue to lack access to Medicaid or Title XXI programs after state CHIP programs currently enacted or contemplated are fully implemented, CHIP has the potential to significantly reduce the number of uninsured children in America. To achieve the full potential of CHIP however, states must be creative and aggressive in their efforts to identify and recruit eligible children. Moreover, our results suggest other ways states can reach greater numbers of uninsured children by designing their CHIP programs in ways that are sensitive to the reasons children lack health insurance. In particular, states should be conscious of how cost sharing might discourage participation and how programs might effectively reach children who have unstable access to private insurance due to their parents’ unstable employment situations.

At the same time however, the need for public insurance in the first place stems from gaps in the provision of employer-sponsored health insurance. About half of children who lack health insurance do so because their parents work for firms that don’t offer health insurance or are ineligible for their employer’s health benefits. This suggests that incremental expansions in public health insurance should not blind us to the continuing need for more fundamental reforms, either through market reforms that will expand employer sponsored coverage or through more a broad based expansion in public funding of health insurance.

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