Federal Child Health Issues: Looking Forward, Looking Backward

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Federal Child Health IssuesLooking Forward,
Looking Backward
Jocelyn Guyer Center for Children and Families
Colleen Chapman Spitfire Strategies
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WHAT HAPPENED? SCHIP Reauthorization
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2007 Wave of Support for SCHIP Reauthorization
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Americans Support Covering Children

• 91
• July 23, 2007

Source Poll conducted by Lake Research Partners
and American Viewpoint, national survey of 1,002
American voters from June 26 - July 1, 2007 for
the Center for Children and Families
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Over 400 Positive Editorials and Headlines
This Health Program is Too Important to Let Die
- Sacramento Bee, July 31, 2007
Lawmakers Must OK Health Coverage for Kids -
Arizona Daily Star, July 30, 2007
Children are Worth It - New Orleans Times
Picayune, July 24, 2007
Insuring All Children The People Want It -
Seattle Post-Intelligencer, July 20, 2007
Health Care Yes, For the Children - Milwaukee
Journal Sentinel, July 20, 2007
Are Healthy Children a Danger? - Boston Globe,
July 12, 2007
Child Health Care Funding is Vital - Denver
Post, July 19, 2007
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Final SCHIP Bill

• Coverage for an additional 4 million uninsured
  children
• 35 billion in funding over 5 years
• Major new initiatives to reach already eligible
  but uninsured Medicaid children
• New child health quality initiative
• BUT
• No new option to cover legal immigrant children
  and pregnant women
• New limitations on covering moderate-income
  children
• Phasing out of adult coverage
• Improvements for citizenship documentation
  requirements, but also applied to SCHIP

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Two Perspectives from Republicans in Iowa
Representative Steve King (R-Iowa) on the House
Floor, 10/18/07
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Two Perspectives from Republicans in Iowa
(continued)
This is a bipartisan compromise. It has broad
support from Republicans and Democrats. It will
help as many as 4 million low income uninsured
childrenIt puts the lowest income children first
in line Here's what it's not It's not a
government takeover of the health system. It
does not undermine immigration policy. It's not
expanding the program to cover high income kids.
Senator Charles Grassley (R-Iowa) on the
Senate Floor, 9/27/07
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A Large Majority of Congress Supported The
Reauthorization Bill(Vote on first major SCHIP
reauthorization bill)
Source Roll No. 906 in the House of
Representatives (September 25, 2007) and Record
Vote No. 353 in the Senate (September 27, 2007)
which sent H.R. 976, the Children's Health
Insurance Program Reauthorization Act of 2007, to
President Bush who vetoed it on October 3, 2007.
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Bush - Why I Vetoed Childrens Health Care
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August 17th Directive

• Issued August 17th, 2007 without notice
• In effect, makes it difficult or impossible for
  states to cover more moderate-income children
• 95 coverage rate
• Minimal decline in employer-based coverage
• Major shift in longstanding SCHIP policy and
  quickly a target for litigation

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SCHIP Extension - S. 2499

• Extended SCHIP through March 31, 2009
• Significant new funding for many states
• Did not address the August 17th directive

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WHERE ARE WE NOW?
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Federal Child Health Issues in 2008

• SCHIP reauthorization likely on the back
  burner until the fall
• Administration using administrative strategies
  to cut Medicaid and SCHIP
• Medicaid regulations
• August 17th SCHIP directive
• 6 of the 7 Medicaid regulations have been
  stopped, but the directive remains in effect

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Update on the Directive

• May 7th Clarifying Letter
• Medicaid expansion states are not subject to the
  directive
• A moratorium on the directive was included in the
  Labor, HHS Appropriations bill, but not likely to
  pass until after August

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Update on the Directive (continued)

• On May 9, 2008, Rhode Island became the first
  state to meet the requirements of the August 17th
  directive
• Serious questions have arisen about Rhode
  Islands data adjustments

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Update on the Directive (continued)

• We said they moved the goal-line for RI (by
  shifting from a 95 enrollment of eligibles to
  95 insurance coverage). Now, we see they ignored
  a fumble, overturned an interception, gave them
  two extra downs - and still had to move the
  goalposts!
• - State official from another state
  commenting on Rhode Islands approval

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At Least 22 States Are Affected by the August
17th CMS Directive
WA
NH
VT
MT
ME
ND
OR
MN
MA
ID
WI
SD
NY
WY
MI
RI
CT
IA
PA
NV
NE
NJ
OH
IL
UT
IN
DE
CO
CA
WV
KS
VA
MD
MO
KY
NC
DC
TN
OK
AZ
SC
AR
NM
AK
GA
AL
MS
LA
TX
HI
FL
States already negatively impacted (8 states)
States with approved plans that must comply by
August 2008 (12 states)
Expansion states with 2008 implementation dates
(3 states)
States deemed by CMS to meet the directive
requirements (1 state - RI)
Note DC covers children above 250 FPL, but
because they are a Medicaid expansion state, they
are not affected by the directive. Ohio is also a
Medicaid expansion state, but they delayed
implementation of their eligibility expansion due
to the directive.
Source Center for Children and
Families, July 2008.
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LOOKING AHEAD
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Key Questions for the Future

• How will SCHIP reauthorization get done?
• Will we have national health reform?
• What administrative actions might a new
  Administration take to quickly improve coverage
  for children?

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Under an Obama Administration

• Options for SCHIP
• Push for quick reauthorization of SCHIP pursue
  more ambitious childrens agenda in health reform
• Hold SCHIP for the larger health reform debate

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Under a McCain Administration

• Options for SCHIP
• Push for quick action on SCHIP
• Shoot for a more ambitious SCHIP bill given
  broader reform is unlikely

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Obama on SCHIP

• If theres one thing all of us should be able
  to agree on, no matter what our political views,
  its that our children should get the treatment
  they need when they need it. And when Im
  president, they will.

Source Barack Obamas comments on Bushs veto of
SCHIP, October 3, 2007.
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McCain on SCHIP
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Talking Points on SCHIP Reauthorization
Background Considerations

• Serious harm to children if reauthorization drags
  on
• SCHIP reauthorization is a first step, not a
  final step, for childrens coverage.
• Despite fears to the contrary, SCHIP
  reauthorization can help pave the way for broader
  reform
• Reauthorization should be as strong as possible
  but overreaching is a risk

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The Imperative for Quick Action on SCHIP

• Given that SCHIP will expire early in the term of
  the new President, quick, decisive action on
  reauthorization will be critical.
• A strong, reauthorization is needed to continue
  coverage for millions of low-income children,
  especially because it will take some time for
  broader health reform to be acted upon and
  implemented

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The Imperative for Quick Action on SCHIP

• Given that SCHIP will expire early in the term of
  the new President, quick, decisive action on
  reauthorization will be critical.
• An early win on SCHIP will show that the new
  Congress and new Administration can start to
  break the gridlock of the Bush years.

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The Imperative for Quick Action on SCHIP

• Given that SCHIP will expire early in the term of
  the new President, quick, decisive action on
  reauthorization will be critical.
• By taking action on common sense, bi-partisan
  legislation, the new Congress and Administration
  can start a working relationship that will pave
  the way for broader reform.

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The Imperative for Quick Action on SCHIP

• A series of short-term SCHIP extensions would
  wreak havoc with childrens coverage
• States will be paralyzed in their efforts to
  move forward
• With the economic downturn causing more families
  than ever to need affordable coverage for their
  children, it is exactly the wrong time to
  introduce massive uncertainty into the future of
  SCHIP
• A series of extensions will drain time and
  energy away from other initiatives, such as
  broader health reform

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The Imperative for Quick Action on SCHIP

• Even after SCHIP reauthorization, the job will
  not be finished. As part of broader reform
• All children in America should have coverage.
• All children should have access to the care they
  need to grow and develop.

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Broader Health Reform What Do Children Need?

• Access to affordable coverage for all children
• Stronger financing structure
• Shortcomings of Medicaids financing structure
• Capped funding in SCHIP
• A benefit package designed for children and their
  unique developmental needs
• High quality care with access to needed providers
• Family-based coverage

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Broader Health Reform Risk Points for Children

• Elimination of SCHIP/Medicaid without an adequate
  replacement
• Failure to acknowledge and address the unique
  needs of children
• Politicians using mandates to claim victory on
  enrollment issues
• Poor coordination between existing programs and
  new initiatives
• Fracturing of coverage within families

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Administrative Actions to Quickly Help Children

• August 17th Directive
• Medicaid Regulations
• Revamping Waiver/ Deficit Reduction Act State
  Plan Amendment Process

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