"Well, there are about 10 million children that aren't covered by health insurance. About 3 million qualify for Medicaid but don't get it, so we're going to reach out and bring more of those kids into the Medicaid program"
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Franklin Raines puts a stark number on a familiar American paradox: millions of children lack insurance even though a substantial share already qualifies for public coverage. The problem is not only eligibility; it is take-up. Families who meet the rules still miss out because forms are confusing, offices are distant, hours conflict with work, and information does not reach the people who need it. Some fear stigma or do not know their children qualify. Others bounce in and out of coverage as income or family circumstances change. Saying, "we are going to reach out", makes policy sound like human contact, not just statutes and budgets.
Raines, as President Clintons budget director in the late 1990s, was speaking during a pivot from failed universal health reform to targeted expansion. The Balanced Budget Act of 1997 created the Childrens Health Insurance Program to cover kids above Medicaid income thresholds, while the administration pushed states to simplify Medicaid enrollment and boost participation among those already eligible. The numbers he cites map neatly onto that strategy: enroll the three million who qualify for Medicaid through outreach and administrative fixes; build SCHIP to reach many of the remaining uninsured.
The emphasis is managerial as much as moral. Enrolling eligible children through an existing program is a high-value use of public funds, producing immediate coverage gains without creating a new entitlement bureaucracy. It focuses attention on implementation details that often determine whether policy succeeds: presumptive eligibility, school-based sign-ups, multilingual assistance, and continuous coverage to reduce churn.
The line also signals a broader lesson about social policy. Eligibility is a promise; enrollment makes it real. Measuring success requires looking beyond laws on paper to the friction people encounter at the front door. By grounding the debate in concrete numbers and practical steps, Raines frames child coverage not as an abstract ideal but as a solvable operational challenge.
Raines, as President Clintons budget director in the late 1990s, was speaking during a pivot from failed universal health reform to targeted expansion. The Balanced Budget Act of 1997 created the Childrens Health Insurance Program to cover kids above Medicaid income thresholds, while the administration pushed states to simplify Medicaid enrollment and boost participation among those already eligible. The numbers he cites map neatly onto that strategy: enroll the three million who qualify for Medicaid through outreach and administrative fixes; build SCHIP to reach many of the remaining uninsured.
The emphasis is managerial as much as moral. Enrolling eligible children through an existing program is a high-value use of public funds, producing immediate coverage gains without creating a new entitlement bureaucracy. It focuses attention on implementation details that often determine whether policy succeeds: presumptive eligibility, school-based sign-ups, multilingual assistance, and continuous coverage to reduce churn.
The line also signals a broader lesson about social policy. Eligibility is a promise; enrollment makes it real. Measuring success requires looking beyond laws on paper to the friction people encounter at the front door. By grounding the debate in concrete numbers and practical steps, Raines frames child coverage not as an abstract ideal but as a solvable operational challenge.
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| Topic | Health |
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