It’s a case of the good news being reported right before the ax falls. Providing children with health insurance makes a huge difference in whether kids receive the care they need, especially if they are chronically ill with such things as asthma or diabetes. The Robert Wood Johnson Foundation released a state-by-state report today, “A Needed Lifeline.” The report was conducted by researchers at the University of Minnesota.

Insured children are three times more likely to have visited a doctor’s office in the course of a year than are uninsured children, according to the report. About 60% of insured children are covered by private insurance plans, and about a third of children are covered under public programs, such as Medicaid (MediCal in California) or the State Children’s Health Insurance Program (SCHIP). The L.A. Times, on Nov. 26, 2007, wrote about how the children’s program can affect even middle-class families. The new report shows that although 41% of chronically ill kids who had no health insurance skipped needed care, only 10% of those covered under public programs skipped needed care.

Last year, a federal directive with an Aug. 18 deadline came down from the Centers for Medicare and Medicaid Services that put some aspects of California’s program at risk. For example, some county programs — with federal permission — that have enrolled children in families earning 300% of the federal poverty level may lose that permission for new enrollees. And all newly enrolled children must be uninsured for a year to qualify, according to the new rules. The old rule said they had to be uninsured for only three months before they could be signed up. Yesterday, the state decided not to comply with the new rules, according to CQ Healthbeat, saying that key requirements run counter to California law.

Congress has voted several short-term extensions of the SCHIP program, the most recent to expire in March 2009. But between now and then — you may have noticed — there’s a general election, and state agencies can’t be sure what will happen to programs for uninsured children. On top of that uncertainty, the new CMS rules have just about everyone scratching their heads.

So the SCHIP program, a success story in dropping the number of uninsured children from 11.1 million in 1998 to 7.9 million in 2004, has just received yet more evidence of its value from the new Robert Wood Johnson study. But with the deadline for the new CMS rules just four days away and no one certain how the feds will respond to California’s refusal to comply, with a change in president certain, and possible changes in every other elective office in the land, is it any wonder that states just don’t know what to do about the millions of children who are still uninsured?