Florida has one of the country’s highest rates of children without health insurance, according to a report released this week by the Commonwealth Foundation.

Florida ranks 47th among out of 50 states plus the District of Colombia on the foundation’s Child Health Care Scorecard (.pdf), trailed by Arizona, Texas, Nevada, and Mississippi. It scores especially poorly on access and affordability, where it ranks 49th, and performs best in terms of “potential to lead healthy lives,” where it ranks 35th.

In 1999, more than 16 percent of children in 11 states were uninsured. Florida, with nearly 18 percent of its children lacking health insurance, is among only three states that remain above that level. Only Texas has a higher rate of uninsured children, while Texas and New Mexico have higher rates of uninsured parents.

The federal health care reform law could help improve the situation, according to the report. Provisions in the law would seek to reduce the number of uninsured adults, increase Medicaid eligibility and provide subsidies for families to buy health insurance could improve children’s access to care:

Provisions in the Patient Protection and Affordable Care Act of 2010, if successfully tested and adopted by private and public payers, could provide substantial relief to families by slowing the growth in health insurance premiums. Yet, before reforms are fully phased in, families will remain at risk.

Given states’ current fiscal duress and their failure to enact comprehensive reforms in the years before the recession, it is unlikely that many will succeed in getting close to universal coverage on their own. The Affordable Care Act provides a common insurance coverage framework and financing to support state efforts, which is especially important for states that face large coverage gaps and socioeconomic challenges.

State officials, led by Gov. Rick Scott, have refused to implement the Affordable Care Act while the state’s legal challenge moves through the courts. The state has been returning grants intended to help pay for the implementation.

Florida could also improve its ranking by increasing access to KidCare, which includes Florida’s version of the State Children’s Health Insurance Program, as the Tallahassee Democrat argues in an editorial:

KidCare, Florida’s low-cost insurance program for very low-income parents, has never been the success story it should have been, with complex application processes and low public awareness that it even exists.

And last month, Florida got no portion of $206 million in federal bonus money for states that have adopted smart KidCare-style enrollment and retention policies, because Florida met only five of eight benchmarks to earn the grants. One easy fix, which lawmakers have so far declined to try, would have set up express-lane eligibility for enrollment by using the Free and Reduced Lunch Program in the public schools as evidence of eligibility. We also make parents renew their KidCare policy every six months, for no apparent reason whatsoever.

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