Getting to the Finish Line on Children’s Coverage

Cindy MannCenter for Children and Families

Georgetown University Health Policy Institute

http://ccf.georgetown.edu

National Health Policy Forum

Universal Coverage for Children:

States Setting the Pace

September 19, 2008

Getting to the Finish Line on Children’s Coverage

Setting the Context

• State economic conditions

• State actions

• Federal actions

Source: E. McNichol and I. Lav, “State Budget Troubles Worsen,” Center on Budget and Policy Priorities (September 8, 2008).

FL

NC

SC

GALATX

AL

AR

KS

OKAZ TN

MS

NVUT CO

NM

CA

WYID

WA

ORND

SD

NE

MT

MN

IA

MO

IN

MI

WI

IL

ME

OH

KY

HI

AK

NY

PA

WV VA

CTNJ

DEMD

RI

NHVT

DC

MA

State Budget Woes WorseningFY 2009

States with Budget Shortfalls in FY09 (30, including DC)

States with Additional Mid-Year Shortfalls (13 states)

Moving Forward Even in Challenging Fiscal Climate

“We are making tough decisions, but we're doing that while also protecting the core priorities, such as education, providing health care to our children and supporting tax reform that I believe will help revitalize our economy in the long run.”

Governor Ted Strickland (D-OH) announcing $540 million in cuts (September 10, 2008)

Source: As of September 4, 2008 based on a review by the Center for Children and Families of state initiatives in 2007 and 2008.

States Moving Forward2008

Implemented 2007 Legislation to Improve Child and Family Coverage (15 states)

FL

NC

SC

GALATX

AL

AR

KS

OKAZ TN

MS

NVUT

NM

CA

WYID

WA

ORND

SD

NE

MT

MO

IN

MI

WI

IL

ME

OH

KY

HI

AK

PA

WV VA

CTNJ

DEMD

RI

NHVT

DC

MA

Enacted New Legislation/Took Administrative Action to Improve Child and Family Coverage (10 states)

CO

IA

NYMN

• In 2008, 19 states authorized new measures or implemented measures approved in 2007

• Continues a 4-year trend: since 2005, two-thirds of states have made significant improvements in their children’s coverage programs

• Changes include improvements to boost enrollment among already-eligible children and eligibility expansions

States Moving Forward

Reaching the Eligible but Unenrolled Children

< 1%

Procedural closings in Louisiana:

Source: LaCHIP/Medicaid Eligibility Division, La. Department of Health & Hospitals, September 2008

Assuring Eligible Children Can be Enrolled

“We have made great strides in improving access to health care for our vulnerable children.”

Governor Huntsman (R-UT) celebrating the 10th Anniversary of SCHIP (August 21, 2008)

Eligibility Changes

• Over the past 4 years, 22 states have enacted eligibility expansions in SCHIP/Medicaid

• Currently, 45 states have enacted legislation to cover children ≥200% of FPL and 20 states have authorized coverage ≥300% of FPL

Premiums for Employer-Sponsored Coverage Are Growing Faster than Workers Earnings

8.2%

20.0%

35.5%

54.3%

71.6%

87.4%

101.8%

114.1%

4.0%

27.0%22.7%

11.6%9.3%6.8%14.2% 17.7%

0%

20%

40%

60%

80%

100%

120%

1999 2000 2001 2002 2003 2004 2005 2006 2007

Health Insurance Premiums Workers Earnings

Source: Center for Children and Families analysis of Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2007; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999-2007 (April to April).

The “Welcome Mat” Effect

STATETotal New Enrollment

Previously Eligible

Illinois 244,700 165,600 (68%)Data from November 2005 - June 2008

Massachusetts 51,000 32,750 (64%)Data from June 2006 - June 2008

Pennsylvania 19,000 11,000 (59%)Data from February 2007 - June 2008

Wisconsin 49,108 40,881 (83%)Data from February 2008 - May 2008

Source: Center for Children and Families,”Putting Out the Welcome Mat: Implications of Coverage Expansions for Already-Eligible Children” (September 9, 2008).

States are Leading the Way but Federal Action is Essential

• SCHIP reauthorization

• August 17th Directive

• FMAP

• Health reform

700,000

2,500,000

600,000

New Children's Enrollment in SCHIP & Medicaid

Note: Average monthly enrollment for fiscal year 2012; SCHIP & Medicaid would cover 5.8 million children when reductions in other coverage are included; numbers may not sum due to rounding.

Source: CBO estimate of changes in SCHIP and Medicaid enrollment of children under the House Amendments to the Senate Amendments to H.R. 976, the Children’s Health Insurance Program Reauthorization Act of 2007 (September 24, 2007).

Children Currently in SCHIP Who Could Lose Coverage

Children Newly Eligible Through SCHIP

Expansions

Uninsured Children Already

Eligible

3.8 Million Otherwise Uninsured Children

Missed Opportunity: CHIPRAWas Projected to Help States Cover Nearly

4 Million Additional Children

84% Eligible Under

Current Program

Rules

What Happens on March 31, 2009?

42

28

No SCHIP Bill Extension with LevelFunding

Source: C. Peterson, “What Happens to SCHIP After March 31, 2009?,” Congressional Research Service (July 22, 2008).

Number of States that Will Face Funding Shortfalls in FY 09

Emily is Waiting

0

10

20

30

40

50

60

70

80

90

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

East

West

North

• The program needs stable funding

• Policy issues addressed in CHIPRA need to be resolved

• Uncertainty can stop or even unravel progress

• But SCHIP reauthorization is not health reform; children as well as adults have much at stake in the broader health reform debate

The Imperative for SCHIP Reauthorization

Americans Support Covering Children

91%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

Why?

“Finally, we must do this -- and do it now -- because supporting children's health is vital to supporting Kentucky's future. So much depends on laying a proper foundation for our children's lives at the earliest possible age. With this KCHIP plan we take a significant step forward toward that goal.”

Governor Steve Beshear (D-KY) “Reversing Course on Children’s Health,” Louisville Courier-Journal (September 14, 2008)