Cindy Mann

1
Key Issues In SCHIP Reauthorization
Cindy Mann Center for Children and Families
Georgetown University Health Policy
Institute www.ccfgeorgetown.org crm32_at_georgetown.e
du Health Journalism 2007
2
Childrens Eligibility for Medicaid/SCHIP by
Income, July 2006
NH
VT
ME
WA
ND
MT
MN
MA
OR
NY
ID
WI
SD
RI
MI
CT
WY
PA
NJ
IA
OH
NE
IN
NV
DE
IL
WV
UT
VA
MD
CO
CA
MO
KS
KY
NC
DC
TN
SC
OK
AR
AZ
NM
GA
AL
MS
TX
LA
AK
FL
HI
gt 200 FPL (15 states)
lt 200 FPL (10 states)
200 FPL (26 states including DC)
Source Based on a national survey conducted by
the Center on Budget and Policy Priorities for
Kaiser Commission of Medicaid and the Uninsured,
2007.
3
(No Transcript)
4
Trends in the Uninsured Rate of Low-Income
Children, 1997- 2005
Source CCF analysis of National Health Interview
Survey.
5
Coverage Gains Over the Past Decade Have Come
Equally from Medicaid SCHIP
Enrollment of Children in Public Coverage
(Millions)
34.0
32.3
30.8
27.2
25.2
23.5
22.3
21.0
Source CCF, Preliminary data. Based on
children ever-enrolled over the course of a year.
6
SCHIP Reauthorization Whats Ahead
7
Childrens Health Care Coverage, 2005

• 88 have at least one employed parent.
• Uninsured children are disproportionately in the
  South (43) and West (29).
• A disproportionate share (38) of uninsured
  children are Hispanic.
• 35 of uninsured children live in families with
  incomes below 100 FPL.

77.9 million children under 19
Source CCF analysis of CPS 2006 March
Supplement and Campaign for Childrens Health
Care, No Shelter from the Storm Americas
Uninsured Children (September 2006).
8
The Political Environment in Washington Much Has
Changed
OUT
IN
Rep. Joe Barton (R-TX)
Rep. John Dingell (D-MI)
9
But Much Remains the Same
Before Elections
After Elections
Federal Budget Deficit (in billions)
Federal Budget Deficit (in billions)
Note Deficit shown is on-budget which excludes
social security and other dedicated
taxes. Source Congressional Budget Office, The
Budget and Economic Outlook An Update (August
2006)
10
Political Environment Outside of Washington

• State fiscal situations stronger
• Health care again a major issue
• Childrens coverage played a role in many state
  gubernatorial elections
• An increasing number of states moving forward
  with major coverage expansions for children
  (e.g., HI, IL, MA, PA, WA)
• Even more are considering proposals (e.g., CA,
  CO, CT, MN, NY, OH, OR, WI)

11
What Are the Key Issues in SCHIP Reauthorization?
12
Key Issues Financing

• Size of the national allotments
• Dividing the allotments among states
• Offsets

13
SCHIP Spending is Rapidly Outpacing New Funds
Being Made Available
(in billions)
Source 1998-2007 data from Chris Peterson. SCHIP
Original Allotments Funding Formula Issues and
Options. Congressional Research Service (October
2006) 2007-2012 spending data from CBO March
2007 SCHIP baseline (February 2007) includes
outlays plus additional SCHP spending required to
maintain current programs.
14
SCHIP Enrollment Projections, 2007-2016
Millions of People
Assumes federal SCHIP allotments remain at 5
billion after FY 2007
Source The Kaiser Commission on Medicaid and the
Uninsured. Additional Detail of the FY 2007
Budget from Office of the Actuary at CMS.
15
Voters Strongly Support Investing More Money in
SCHIP
Which statement best describes your thoughts on
what Congress should do about SCHIP?
Increase SCHIP funding so that it can cover even
more uninsured children
82 Support investing more money in SCHIP
Dont know/ refuse
Increase SCHIP funding so that it can continue to
cover the current number of children
Fund SCHIP at current levels even though some
children will lose coverage
Source Poll conducted by Lake Research Partners
for CCF (November 2006).
16
Dividing the Dollars
Targeting the dollars to children?
Formula fight among states?
17
Childrens Coverage vs. Special Interests?

• Paygo rules require offsets
• Cuts in other spending
• New revenues/closing down current
  loopholes

18
Key Issues Financing (cont)

• Reducing costs by limiting who can be covered
  with SCHIP funds
• Children over 200 of FPL (40,000/year for a
  family of four)
• Adults (mostly parents)

19
SCHIP Enrollment by Category (2006)
Parents of Children in Medicaid/SCHIP
Children and Pregnant Women
Adults without Children
7.4 Million SCHIP Enrollees
Note Ever-enrolled over the course of a
year. Source CBO March 2007 Baseline State
Childrens Health Insurance Program (February 23,
2007).
20
(Some of the) States with SCHIP Populations
Targeted for Cuts (March 2007)
NH
VT
ME
WA
ND
MT
MN
MA
OR
NY
ID
SD
WI
RI
MI
CT
WY
PA
NJ
IA
OH
NE
IN
NV
DE
IL
WV
UT
VA
MD
CO
MO
CA
KS
KY
NC
DC
TN
SC
OK
AR
NM
AZ
GA
AL
MS
TX
LA
AK
FL
HI
Children gt200 FPL (17 states)
Adults (14states)
Note Adults include waiver-based coverage for
pregnant women, parents of children in
Medicaid/SCHIP, and adults without children. In
February 2007, Pennsylvania received CMS approval
to expand SCHIP eligibility to 300 FPL.
Additional states could be affected depending on
how the limits are defined. Source CCF, States
Affected by Proposals to Reduce SCHIP Coverage
Options (February 7, 2007).
21
What Will Twice the Poverty Level Buy?
Purchasing power of 200 FPL by select
metropolitan areas adjusted for the cost of
living.
200 FPL
Note In 2006, 200 FPL for a family of three was
33,200 annually. Source CCF analysis using
2006 ACCRA data.
22
Meet the Chappell Family

• Beverly and her husband both work and raise their
  two children, Nathan and Rebecca, in NH. The
  familys yearly income varies between 40,000 and
  50,000.
• Years ago, they had insurance through work but
  also much debt.
• Children covered by SCHIP in NH 50-90/monthly
  premiums. Parents are uninsured because of costs.
• Nathans asthma now well managed no more ER
  visits.
• Nathan would lose his coverage if NH no longer
  covered families with incomes above 200 of the
  poverty level.

23
Median Medicaid/SCHIP Income Eligibility
Threshold, July 2006
Poverty Line for a Family of 3 16,600 (2006)
Note Eligibility levels for parents are based
on the income threshold applied to a working
parent in a family of 3
Source Based on a national survey conducted by
the Center on Budget and Policy Priorities for
KCMU, 2007.
24
Meet Sawsan Hamad

• Mother of 4, working and going to school in
  Arizona
• Total family income, 22,400
• Access only to very limited health insurance
  through her job/school
• Ms. Hamad and her children have SCHIP 35/month
  in premiums
• Last summer, Ms. Hamad was diagnosed with cancer
  with SCHIP-funded coverage she is getting needed
  treatment.

25
Other Key Issues

• Lifting restrictions on immigrant coverage
• Subsidizing employer based coverage
• New DRA rules requiring families to document
  citizenship
• Incentives and supports for moving forward

26
Children's Enrollment in Washington's Public
Insurance Programs April 2002-April 2005
July 2003 12-month continuous eligibility ends
6-month renewal cycle replaces 12-month cycle
April 2003 State begins income verification
January 2005 Administrative order to return to
12-month renewal cycle and establishes continuous
eligibility policy
Source Washington State Department of Social and
Health Services, 2005.
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Whats Ahead?

• Strong track record
• Many states eager to move forward
• Strong public and bipartisan support
• But dont assume smooth sailing