Children’s Health Care and SCHIP
The State Children’s
Health Insurance Program, known as SCHIP, is up for reauthorization this year. This
reauthorization is an important opportunity for Congress to strengthen and expand children’s health coverage, to move
our country toward providing health care for all children, and to renew our national discussion about how to make sure all
Americans have access to quality, affordable health coverage.
Background
Reauthorization
NAC Position
More Info
Background
SCHIP was created in 1997
to increase health insurance coverage for low-income children. It was designed to complement Medicaid coverage and to reach
children in families who earned too much to be eligible for Medicaid but for whom employer-sponsored health insurance was
not available and private health insurance was not affordable. SCHIP provided
states with $40 billion over 10 years and broad parameters to develop programs to cover children in families at up to 200%
of the federal poverty level (FPL). Because of the flexibility that states were allowed under the 1997 legislation, there
is no one standard SCHIP program. Some states have chosen to set higher income
limits (NJ covers kids up to 350% of the FPL), a few have set lower income limits (in ND and MT eligibility is set at 150%
of the FPL), and some states have used waivers to cover low-income parents, recognizing that children were more likely to
get the health care they needed if their parents had access to care. In addition, the benefits provided vary from state to
state (but must meet a minimum standard) and some state programs charge premiums and require co-pays for SCHIP coverage.
Since SCHIP was enacted,
the number of uninsured children has dropped by 2.7 million and the number of low-income uninsured children has dropped by
one-third (Health Insurance Coverage of America’s Children (PDF): Kaiser Family Foundation, Jan. 2007)—this despite rising health care costs, declines in employer-provided
health coverage, and increases in the overall number of Americans without health insurance.
SCHIP covers roughly 6 million children each year and Medicaid and SCHIP combined cover about a quarter of all U.S. children.
However, despite this progress
some 9 million children remain uninsured. Two-thirds of these uninsured children are eligible for either SCHIP or Medicaid,
but inadequate funding, complicated enrollment and renewal procedures, and lack of information have often made it difficult
for them to access coverage. In addition, federal law prevents legal immigrant
children from accessing SCHIP or Medicaid until they have been in the country for five years.
In some states, inadequate funding has forced cutbacks and at times, most recently in May of this year, the federal
government has had to provide additional “emergency” funding to prevent shortfalls and coverage losses.
Even with these problems,
SCHIP has been a largely successful program that has increased low-income children’s access to needed health services
and improved their health outcomes. Building on the success of SCHIP, a number
of states are moving to increase children’s health coverage, but support from the federal government, through a strong
SCHIP reauthorization, is critical to moving our country toward making sure that all children have access to the health care
they need.
Reauthorization
Many health care and children’s
advocacy groups began laying the groundwork for SCHIP reauthorization in 2006, calling on Congress not just to renew the program,
but to provide significant new investments to expand children’s health coverage.
Some key principles in these efforts, which the National Advocacy Center has supported, are:
- Provide $60 billion in new funding for children’s health
- Offer states new options and tools to expand coverage, including coverage for pregnant women and legal
immigrant children, and enroll more eligible children
- Promote coverage that facilities the healthy development of children, including mental health and dental
care
- Keep existing coverage strong – make no changes to SCHIP or Medicaid that would result in losses
of coverage
Congress took the first step toward a strong SCHIP reauthorization by setting
aside $50 billion for reauthorization in the budget resolution. Though less than
what advocates had hoped for, this is still a significant new investment in children’s health care. However, because of the Pay-As-You-Go or PAYGO budget rules adopted by the new Congress to help reduce
the deficit, this $50 billion is contingent upon finding offsets—either savings in other programs or new revenues. Given the tight budget situation, funding is likely to be one of the most contentious
reauthorization issues, but $50 billion is the minimum needed to maintain current
coverage and reach all eligible children. If SCHIP were simply extended at current funding levels, states would experiences
significant funding shortfalls (due mostly to increasing health costs) that, according to the Center on Budget and Policy Priorities, hundreds of thousands of children would lose health coverage over the next five years.
What now remains is for the
appropriate committees (Finance in the Senate and Energy & Commerce in the House) to begin drafting SCHIP reauthorization legislation and identifying those offsets needed to fully fund
the $50 billion commitment made in the budget resolution. The Senate Finance Committee is expected to act first and “mark-up”
a bill before the end of June. The House Energy and Commerce Committee mark-up isn’t scheduled until after the 4th
of July recess, which means that both the House and Senate will be working with a very tight time frame to get the program
reauthorized before the end of the fiscal year (Sept. 30th).
In the meantime, several
members of Congress have introduced their own children’s health care bills, some of which focus on SCHIP and some of
which are broader. Brief summaries of some of the bills are available at the Georgetown University Health Policy Institute Center for Children and Families and the Children’s Partnership. The original Senate sponsors of the SCHIP program, Senators Kennedy (D-MA) and Hatch (R-UT), have also released principles for reauthorization to indicate their priorities in the debate. More detailed summaries of some of the key bills are listed below. These
bills provide important “markers” of the priorities in SCHIP reauthorization and contain many good policies that
we hope will make it into law, but reauthorization will ultimately depend more on the work of the Senate Finance and House
Energy and Commerce Committees and on the floor debate.
S 1224—The Children's Health Insurance Program (CHIP) Reauthorization
Act of 2007, Lead Sponsors: Senators John Rockefeller (D-WV) and Olympia Snowe (R-ME)
- Summary from Georgetown
Center for Children and Families
- Summary from Senator Rockefeller’s Office
S 895/HR 1535—The Children’s Health First Act, Lead Sponsors: Senator Clinton (D-NY), Representative John Dingell (D-MI)
- Resources from the House Energy and Commerce Committee
S 1364/HR 2147—The Healthy Kids Act of 2007, Lead Sponsors: Senator Ron Wyden (D-OR) and Representative Rahm Emanuel (D-IL)
- Summary (PDF) from the Alliance for Health
Reform
S 1564/HR 1688—All Healthy Children Act of 2007, Leader Sponsors: Senator Bernie Sanders (I-VT) and Representative Bobby Scott
(D-VA)
- Summary from the Children’s Defense Fund
S.764/H.R.1308—Legal Immigrant Children’s Health Improvement Act of 2007, Lead Sponsors Senator Hillary Clinton (D-NY) and
Representative Lincoln Diaz-Balart (R-FL)
- Resources from the National Immigration
Law Center
NAC Position
Grounded in a fundamental
commitment to the life and dignity of every person, the National Advocacy Center believes that access to quality, affordable health care is a basic human right and essential to a healthy and just
society. We recognize roles and responsibilities within all parts of society
to help move us toward quality, affordable health care for all, but national leadership is critical and Congress has an important
opportunity to act this year. As a step toward the goal of universal health coverage, we urged Congress earlier this year
to provide enough funding in SCHIP reauthorization to cover ALL children. The $50 billion provided by Congress is already
a compromise, but still an important investment that will ensure that all eligible children can be covered and must be preserved
during the House and Senate mark-ups and debates. As the process moves forward,
the National Advocacy Center will continue to urge Congress to:
- Fulfill the commitment of at
least $50 billion in new funding for SCHIP. This
amount is the minimum needed to maintain current coverage, reach out to children
already eligible for SCHIP or Medicaid but not currently covered, and to allow states to begin expanding coverage.
- Include
new tools, options, and supports for states to cover more children. Express
Lane Eligibility and other enrollment/renewal simplifications, options to cover pregnant women and legal immigrant children
and pregnant women (Legal Immigrant Children’s Health Improvement Act), and financial incentives for states to increase
outreach would help reach and retain more eligible children. In addition, we
support efforts to extend expand eligibility to low-income young adults up to age 21, particularly youth aging out of foster
care.
- Promote
access to all medically necessary services. Comprehensive benefits, including
mental health and dental care, are critical to ensuring that children receive the health care they need.
- Do
NO harm to current coverage. Medicaid should not be weakened in any way
to finance improvements in SCHIP and states that have expanded income eligibility and chosen to cover parents as a way of
reaching more children should not be undermined.
As the SCHIP debate unfolds,
we will try to provide updates and additional information. In meantime, to learn more about SCHIP, uninsured children, and
options for reauthorization, please check out some of the links below.
For More Information
SCHIP/Medicaid Background
SCHIP 101 (PDF): Families USA
Medicaid/SCHIP Reports: Kaiser Family Foundation
SCHIP Portal: Georgetown University Health Policy Institute, Center for Children
and Families
Children’s Health Coverage
Children’s Health Coverage Tutorial (animated): KaiserEDU
State Profiles (including benefits, eligibility, etc): Kaiser Family Foundation
The Great Divide: When Kids Get Sick, Insurance Matters: Families USA
Reauthorization Principles and Campaigns
Too Close to Turn Back, Making Real Gains for Children, Moving Forward (PDF files): Reports and recommendations from the Georgetown
University Health Policy Institute, Center for Children and Families
The Campaign for Children’s Health Care: Families USA +
dozens of other national, state, and local organizations
Cover all Children Campaign: PICO Network
Healthy Child Campaign: Children’s Defense Fund
