SCHIP Reauthorization: Where We Are and Key Issues

Dawn HornerGeorgetown University Health Policy Institute

Center for Children and Familiesdch28@georgetown.edu

ccf.georgetown.edu

National Association of CountiesJuly 14, 2007

SCHIP Reauthorization:Where We Are and Key Issues

A National Priority

• Strong public and bipartisan support for covering children

• Great track record

• Many states poised to move forward

• Congress should assure funding and policies are in place to keep moving in the right direction

Voters Strongly Support Investing More Money in SCHIP

4%

14%26%

56%

Source: Poll conducted by Lake Research Partners for CCF (November 2006).

Fund SCHIP at current levels even

though some children will lose

coverage

Increase SCHIP funding so that it can continue to

cover the current number of children

Increase SCHIP funding so that it can

cover even more uninsured children

Don’t know/ refuse

Which statement best describes your thoughts on what Congress should do about SCHIP?

82%

Support investing

more money in SCHIP

AZAR

MS

LA

WA

MN

ND

WY

ID

UTCO

OR

NV

CA

MT

IA

WIMI

NE

SD

ME

MOKS

OHIN

NY

IL

KY

TNNC

NH

MA

VT

PA

VAWV

CTNJ

DE

MD

RI

HI

DC

AK

SCNM

OK

GA

Source: Based on a national survey conducted by the Center on Budget and Policy Priorities for Kaiser Commission of Medicaid and the Uninsured, 2006.

TX

IL

200% FPL (26 states including DC)

FL

AL

> 200% FPL (15 states)

< 200% FPL (10 states)

Children’s Eligibility for Medicaid/SCHIP by Income, July 2006

Source: Kaiser Commission on Medicaid and the Uninsured analysis of CBO March 2006 baseline and CMS Statistical Enrollment Data System, 2006; and CMS FY 2005 SCHIP Enrollment Report (July 12, 2006).

Children’s Enrollment in Medicaid and SCHIP, 2005

Regular Medicaid SCHIP

28 million

6 million

1.7 million are in SCHIP-financed

Medicaid expansions

4.4 million are in separate SCHIP

programs

22.3%21.5%

20.1% 20.0%

18.0%

15.8% 15.9%

14.9%15.2%

1997 1998 1999 2000 2001 2002 2003 2004 2005

Uninsured rate of low-income children under 19

Trends in the Uninsured Rate of Low-Income Children, 1997- 2005

Source: CCF analysis of National Health Interview Survey.

AZAR

MS

LA

WA

MN

ND

WY

ID

UTCO

OR

NV

CA

MT

IA

WIMI

NE

SD

ME

MOKS

OHIN

NY

IL

KY

TNNC

NH

MA

VT

PA

VAWV

CT

NJ

DE

MD

RI

HI

DC

AK

SC

NMOK

GA

Source: As of June 8, 2007 based on CCF review of state initiatives.

TX

IL

FL

AL

Implemented or Recently Adopted Legislation to Improve Children’s Coverage (18 states and DC)

Considering Significant Proposal to Improve Children’s Coverage (11 states)

States are Moving Forward

1. Financing (up to $50 billion in budget resolution)

2. Reaching eligible but uninsured children

3. State flexibility to decide which children and populations to cover

SCHIP Reauthorization – Key Issues

Financing

Stable funding needed to:

• Assure that no one loses coverage: 40 state facing shortfalls.

• Support states’ efforts to expand and improve coverage for children.

• Congressional budget resolution passed earlier this year; up to $50 set aside for SCHIP and Medicaid.

$3.8

$4.3$4.6

$5.1

$6.0$6.2

$4.2 $4.2 $4.2 $4.2

$0.1

$0.9

$2.7

$1.9

$5.0

$5.0$4.1

$3.2$3.2$3.1

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

SCHIP Spending SCHIP Allotment

SCHIP Needs are Outpacing State Allotments

(in billions)

Source: 1998-2007 data from Chris Peterson. SCHIP Original Allotments: Funding Formula Issues and Options. Congressional Research Service (October 2006). FY2006 and FY2007 spending are projected.

7 out of 10 Uninsured Children are Eligible But Unenrolled

49% are Medicaid Eligible

19% are SCHIP Eligible

Source: L.Dubay analysis of March 2005 Current Population Survey using July 2004 state eligibility rules

Medicaid & SCHIP are Reaching an

Increasing Share of Eligible Children

73%

48%

82%

68%

0%

20%

40%

60%

80%

100%

Source: 1999 & 2002 National Survey of America’s Families.

SCHIPMedicaid

1999 2002 1999 2002

Eligible but Uninsured

• Assistance to states that are moving forward.– Medicaid “woodwork effect”

• New tools for identifying and enrolling eligible children.– Express Lane– Citizenship Documentation

State Flexibility

• Original SCHIP law gave state’s flexibility, need to retain and expand.

• Children: 18 states had income eligibility thresholds above 200% FPL. (May 2007)

• Parents: 11 states cover parents through waivers. (May 2007)

• Legal immigrant children.

91.3% 8.7%

Most Children Covered by SCHIP Have Family Incomes Below 200% FPL

At or Below 200% FPL

Above 200% FPL

Note: The reporting classification of a child with family income above 200% FPL who is determined to be eligible at or below 200% FPL due to deductions or disregards (i.e., a net income test) is up to the discretion of the state and constrained by their reporting systems.

Source: C. Peterson & E. Herz, Estimates of SCHIP Child Enrollees Up to 200% of Poverty, Above 200% of Poverty, and of SCHIP Adult Enrollees, Congressional Research Service (March 13, 2007).

6.7 million children enrolled in SCHIP, 2006

$51,128

$41,732

$29,681

$33,200

$28,552

$10

$15

$20

$25

$30

$35

$40

$45

$50

Durham, NC Omaha, NE Milwaukee, WI Philadelphia,PA

San Jose, CA

Th

ou

san

ds

The Cost of Living Differs Across the Country

Note: In 2006, 200% FPL for a family of three was $33,200 annually.

Source: CCF analysis using 2006 ACCRA data.

The cost of goods and services worth $33,200 in the average city, adjusted

for the cost of living.

200% FPL for a family of 3

ESI Coverage Rates Have Declined for Children and Adults

Source: Percent with employer-sponsored insurance from E. Gould, “Health Insurance Eroding for Working Families,” Economic Policy Institute (September 2006).

65.40%

58.90%60.80%

55.40%

Children under 18 Working Adults

1999-2000 2004-2005

Timeline for Congressional Action??

July17

Late July

Mid-July

LateJuly

August Sept30

SenateFinance

CommitteeSenateFloor

House Energy

and CommerceCommittee

House Floor Conference

No new funds available

Note: These dates are all tentative

Senate Finance Mark

• Bi-partisan agreement sets aside $35 billion over 5 years.

• Financing through 61 cent increase in tobacco tax.

• New funds used to increase SCHIP allotments and help states that increase enrollment of already-eligible children.

Senate Finance Mark: Possible Policies

• Restrictions to eligibility.

• Express Lane as demonstration.

• Parents and adults transitioned off.

• No state option to cover legal immigrant children.

• Unclear if will address citizenship doc.

Next Steps/Challenges Ahead

• Facing change in tone in last weeks.

• Bi-partisan agreement important step in process.

• House mark-up offers another opportunity.