It is not the best of times for children in our state. In fact, child advocates within and outside the North Carolina General Assembly are having a dickens of a time defending vital investments in child well-being. Even our state's proven successes for kids are coming under attack.
Just take the example of children's health insurance. In 1998, Governor Hunt called a special session of the state legislature to deal with one issue - children's health insurance.
The General Assembly ended up creating two new programs. The first is NC Health Choice for Children, which provides health insurance to the children of modest-income, working families (who earn up to twice as much as the federal poverty level -- roughly $35,000 for a family of four). Developing Health Choice was the raison d'etre for the special session. These are the working families making too much to qualify for Medicaid, but too little to pay for private health insurance. One attractive feature of NC Health Choice is that it secures three federal dollars for every one state dollar.
The second program created was the state tax credit for families earning up to $100,000 who have certain types of child health coverage. There are no federal matching funds for this NC tax credit program. Consequently, the State of North Carolina absorbs 100 percent of the cost of this subsidy to wealthy families that are eligible.
What's happened to our children who fall into these two separate programs? An impressive state-local, public-private outreach effort earned NC Health Choice the reputation as the best program in America. In two years, 70,000 young North Carolinians gained effective access to health care for the first time. For instance, thousands of children received their first pair of prescription eyeglasses through NC Health Choice.
Ironically, the program succeeded so well that the State imposed an enrollment freeze as of January 1, 2001. There are hundreds of millions in federal funds still available to NC, but no state funds left to trigger the federal match.
So, the State announced that Health Choice would place eligible children on a waiting list. More than 15,000 kids still are waiting today.
What the State didn't announce, however, is that wealthier families would keep receiving 100 percent of the new NC tax credit for already insured children. No cap on state dollars here. No freeze. No waiting list.
These two programs grew out of the same special legislative session. The one for less affluent families was pruned back, while the other continues to blossom and bear fruit for more affluent families. Meanwhile, the gap between the "haves" and the "have nots" widens (while the state budget crisis remains unsolved).
"Them that's got shall get; them's that's not shall lose" makes a great song lyric -- but terrible public policy. It's unethical and irrational for the General Assembly to turn its back on the very children for whom the federal program was created. All children should have effective access to first-rate, affordable health care. The problem arises when higher income, already insured families benefit from a new state tax credit while 15,000 uninsured children from wait-listed, modest income, working, tax-paying families are left out in the cold by this freeze.
Of course, there is a difference in scale between $100 tax credit for a family earning $100,000 versus health insurance for a family earning $30,000. It may be equitable and politically wise to continue both subsidies. Both are a more worthwhile investment of public resources than many current tax loopholes and state appropriations.
However, if our political leaders will neither raise enough revenues nor close enough loopholes to absorb the cost of both NC Health Choice and this tax credit, then simple fairness and common sense demand that Health Choice be given priority. Leaving modest-income working families entirely without children's health insurance, while maintaining this new tax credit for more affluent, insured families would be short-sighted and just plain wrong.
If North Carolina lawmakers cannot find other sources of funding, eliminating the $19 million tax credit would cover every child on the NC Health Choice waiting list. It also would generate an additional $60 million in federal health insurance funds for NC's children.
Re-opening enrollment in NC Health Choice will keep this from being the worst of times for our state's uninsured children. It's time North Carolina's lawmakers lifted the freeze on the NC Health Choice for Children and move our uninsured children from the government's waiting list to the doctor's waiting room.
Sher is president of the NC Child Advocacy Institute. 
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