While the rest of the country has maintained or increased health programs for children, Arizona has become an outlier.

To help close multibillion-dollar deficits in the past three budget years, Gov. Jan Brewer and state lawmakers have frozen the health-insurance program for children of the working poor, eliminated coverage for their parents, wiped out early-intervention programs for families at risk and cut services for children with developmental delays.

Arizona's perennially poor showing in state surveys on child well-being, including a Commonwealth Fund report released today, reflect budget cuts that health experts warn can have lifelong health consequences for children and pose potential public-health threats.

"Cutting off children - that's a trend in the wrong direction," said Cathy Schoen, co-author of the report and a senior vice president with the Commonwealth Fund, a nonpartisan foundation focused on health-care improvement, based in New York City.

Arizona scored 49th in the report, which compared 20 indicators of health-system performance in 50 states and the District of Columbia.

The state was behind Mississippi, Texas, Florida and Nevada in the percentage of uninsured children, at 15 percent, but the rankings were based on 2009 data, before the state implemented some of the significant cuts.

Enrollment in KidsCare, the federal children's health-insurance program, has plummeted by more than 50 percent since Brewer and lawmakers capped it at the end of 2009 to help balance a midyear budget deficit.

About 22,000 children remain on KidsCare, compared with 43,460 when the program was capped, and nearly 66,000 in June 2008. Another 85,000 kids are on a waiting list, but it's not clear how many of them would qualify.

Even as the recession strafed states' revenue, 35 states expanded coverage for children, and the rest maintained their insurance programs for kids.

"It really puts kids and families behind, and it puts our economy behind," said Dana Naimark, president and CEO of the Children's Action Alliance. "When we stand out like this, businesses notice."

Monica Coury, spokeswoman for the Arizona Health Care Cost Containment System, Arizona's Medicaid program, said children and families enrolled in AHCCCS fare better than the national average.

"We don't want this report to reflect on the health care that Arizona children are getting," Coury said. "In a world of finite resources, AHCCCS continues to perform above most other states' Medicaid . . . programs."

Local pediatricians say they've lost patients in the past year who have fallen off KidsCare or private health insurance.

Those children are more likely to suffer from worsening chronic conditions, such as asthma and diabetes, and missed diagnoses for autism and developmental delays, doctors say.

"I see people skipping their well checks," said Dr. Amy Shoptaugh, a Tempe pediatrician. "If they're not coming in for well visits, they're not coming in for vaccines. And that's a risk to the community."

Doctors say they also miss opportunities to educate parents about keeping kids healthy, from nutrition to risky teen behaviors.

In the past decade, Arizona had become a national model for its health-care programs for families and children, said Jocelyn Guyer, co-executive director of the Center for Children and Families at Georgetown University's Health Policy Institute.

"It's really just in the past couple of years that Arizona has jumped off the path and become an outlier," Guyer said. "That's part of what's particularly distressing."