Preserving health insurance for children – and celebrating progress

With insurance coverage now above 98 percent for children in King County, nearly all children have health insurance – and full access to our health care system. This means these kids and youth can get their immunizations and catch health problems early, such as asthma, autism or cancer.

Coupled with King County’s new Best Starts for Kids initiative, we are closer than ever to ensuring that all kids get the best start in life.

These successes – and in particular, nearly universal insurance coverage for kids – didn’t come easily and deserve recognition.

How we got here

In the late 1990s, nearly eight percent of King County children were uninsured. A huge step happened in 1997, when Congress created S-CHIP (now known as CHIP), the Children’s Health Insurance Program. CHIP provides health coverage for children whose families earn too much to qualify for Medicaid, but who cannot afford private coverage. Like Medicaid, CHIP is administered by states using both state and federal funding.

And in the early 2000s, through the Washington State Campaign for Kids, King County helped enroll 16,000 kids in health insurance.

Then, in 2007, the state legislature and governor teamed up to pass the “Cover All Kids” law, which expanded the Medicaid program for low income children and phased in subsidized coverage for children who wouldn’t qualify for Medicaid. It also created a unified, comprehensive children’s health program called Apple Health for Kids, which blends Medicaid and CHIP.

The law relied on the work of the Health Coalition for Children and Youth, including health care and advocacy groups, to get really smart about outreach and education. The efforts kept Washington’s uninsured rate low, even as the Great Recession pushed up uninsured rates everywhere.

By January of 2012, more than 43,000 children were covered by CHIP in Washington, including nearly 6,000 in King County. Still, five percent of children remained uninsured.

In 2013, the Affordable Care Act introduced an expansion of Medicaid, new funding to extend the eligibility for CHIP, and the launch of the health insurance exchange, Washington Healthplanfinder, with health care Navigators.  Together these four – CHIP, outreach, Navigators, and the availability of Healthplanfinder’s seamless system to cover all members of a family – have reduced the burdens of applying for insurance and raised awareness.

Impact: Nearly universal health insurance for kids

The impact in King County is huge, with the uninsured rate falling to a record low, just 1.9 percent – and more than 20,000 children gaining insurance.

The number of children covered through CHIP in King County has nearly doubled since the launch of Washington Healthplanfinder in 2013, increasing to 11,550 – as working parents get insurance for themselves and their children.

Unfortunately, the CHIP program was due for Congressional reauthorization this past September, but the deadline passed without action. Unless Congress reauthorizes CHIP in the next month, many states will begin running out of funding for the program.

In Washington, the program runs out of money to pay for CHIP at the end of November. Notices could be sent to families as soon as December, and thousands of children may be dropped from coverage in February.

As Congress works on CHIP reauthorization, Public Health—Seattle & King County is using four key principles to evaluate all proposals:

Above all else, children are insured

  • Working families can get kids insured who can’t afford private coverage

Maintain a seamless safety net

  • Apple Health for Kids, Medicaid, CHIP, Washington Healthplanfinder, and Best Starts for Kids create a seamless safety net for families and their kids, including insurance coverage and critical resources

Don’t rob Peter to pay Paul

  • Congress has proposed cuts to the Public Health & Prevention Fund to help pay for the CHIP program, but this fund is critical to controlling disease outbreaks, preventing lead exposure for children, and promoting smoke-free housing for families.

Minimize confusion by acting swiftly

  • Confusion around enrollment could lead to children losing access to critical health services. The longer Congress delays reauthorization, the more it risks severely and unnecessarily confusing clients who believe they are losing coverage, and then may have to re-enroll if CHIP is later reauthorized.

Three personal Stories: How CHIP makes a difference:

My husband and I have insurance coverage for ourselves through our employers, however, to add our son, it would cost us an additional $300.00 per month. My son suffers from Asthma and has to have an Albuterol inhaler available to him at school should he need it.  I fear that without the CHIP program the medication would be costly and potentially financially out of our reach.  He also suffer from season allergies that can exasperate his asthma symptoms, therefore, we also need to have the allergy pills available for when his symptoms are present to avoid his breathing difficulties.

I fear that if my son ends up without insurance coverage, we would have a difficult time in obtaining his medications and keeping his asthma under control.


My husband was working for an employer in the late 1990s who did not offer health insurance and I was a “stay-at-home-mom” caring for two children with special needs. Thankfully, we were able to make a small payment every month that allowed our daughters to receive all the care they needed through the (S)CHIP program.  We were lucky enough to be able to get full health insurance coverage through a new employer in 2002, but I will remain forever grateful for the CHIP being there to step in and help my girls through their health challenges.


My son is on the CHIP program. I cannot tell you how grateful I am that this program exists. I can’t afford to add him to my insurance because of the deductibles, max out of pocket and co-insurance. My son has had 3 surgeries in the past 3 years and because of the CHIP program we have been able to manage financially.

Originally published Nov. 1, 2017

Posted by

I'm part of the communications team at Public Health - Seattle & King County and work closely with all of the programs in the Community Health Services Division.