SCHIP Reauthorization: What’s all the fuss about?

Brenda Ritson, PGY-2

Community Pediatrics Fall 2007

What is SCHIP?

• SCHIP is the State Children’s Health Insurance Program and it was created as part of the Balanced Budget Act of 1997

• SCHIP is the largest expansion of public health insurance coverage since the creation of Medicare and Medicaid in 1965

• It is relatively small in size as compared to Medicaid• SCHIP eligibility and coverage is regulated by State

governments and therefore it is different in every State!!!• Just to be clear…SCHIP is NOT the same as Medicaid

Who is Eligible?

• SCHIP was designed to serve “targeted low-income children,” which was defined as uninsured children under age 19 in families with incomes below 200% of the federal poverty level (FPL) ($34,340 for a family of 3 in 2007)

• But because each state has a say in how they run their program, eligibility requirements differ by state

Who is NOT eligible?

• Children who are otherwise eligible for Medicaid or have other insurance coverage are generally NOT eligible for SCHIP

• Adults are also generally NOT eligible for SCHIP; however, several states have been granted special federal approval to receive enhanced matching funds for coverage of parents of children enrolled in SCHIP, pregnant women, and in some cases, adults without childrenthough going forward this has been prohibited by the Deficit Reduction Act of 2006

Now let’s take a look at the numbers!

• 59 million children are covered by either employer based health care insurance plans or privately purchased plans

• Currently, there are 28 million children covered by Medicaid & an additional 6 million covered through SCHIP

• This leaves approximately 9.4 million US children UNINSURED!!!!

– Interestingly enough, currently 2/3 of these children are eligible, but NOT enrolled in either Medicaid or SCHIP

• Overall, 1 in 4 US children are covered by either Medicaid or SCHIP

Health Insurance Coverage of All Children vs. Low-Income Children, 2005

Total = 78 Million Children

Employer-Sponsored Medicaid/

Other Public

Uninsured

PrivateNon-Group

*Low-income is below 200% of Federal Poverty Level.SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute analysis based on the Census Bureau’s March 2006 Current Population Survey, September 2006.

Total = 33 Million Low-Income* Children

Medicaid/Other Public

Uninsured

Employer-Sponsored

PrivateNon-Group

Exhibit 2

Return to KaiserEDU.org

52%

4%

25%

56%

12%

28%

4%

How is SCHIP Financed?

• SCHIP provides a capped amount of federal funds to states on a matching basis

• It must be reauthorized—meaning reviewed, voted on, and presented to the president periodically!

• In 1997, the SCHIP was authorized for 10 federal fiscal years (1998 through 2007)

• When created, $39 billion of federal funds were made available to states

• Each state receives annual SCHIP allotments that can be spent over a 3 year period

Why is it getting so much press NOW?

• BECAUSE it EXPIRED September 30, 2007!!!!• Currently the program is running under a

temporary funding measure that will expire next Friday, November 16th!

• And there is a lot at stake– We have the opportunity to cover more kids and help

out many more working class families!

• And it is a relatively bipartisan issue…the expansion bill passed both the House and the Senate!

Slippery Slope? Moral Dilemma? Or Does it Just Come Down to $?

Is the Urgency Real?

• Technically speaking…the temporary funding measure for the SCHIP program will run out next Friday, November 16th!– A deal needs to be struck

– Or a temporary funding measure must passed to buy some time and keep coverage going!

• Unfortunately, mainly philosophical differences really stand in the way…

3 Major Points of Contention

• Provisions to prevent undocumented immigrants from enrolling in the program

• Creating incentives for states to offer premium assistance to low-income families to purchase private insurancefear of “crowd-out”

• Creating mechanisms that would prevent states from enrolling children in families with annual incomes great than 250% of FPL before enrolling children in families with annual incomes less than 200% of the FPL

And the Bottom Line:

• $35 billion over 5 years for expansion which would cover an additional 10 million children

• Congress is currently trying to negotiate a 3rd version of the bill

• Dems would need to recruit approximately 15 House Republicans to support a new version of the bill that would allow Congress to override an expected 3rd Bush veto

So What Can You Do About it Now?

• Of course, you could send a letter to your Congressmen

• BUT why not send a letter or call the office of the 1 of the 15 House of Representative Republicans that need to change their mind and vote differently to block yet another Bush veto?

• (NOTE: Names and Contact details to be made available over the weekend!)

Because honestly her health is at stake and so is that of many

of your patients!