Fight Over Kids' Insurance
June 18, 2007
By KEVIN FREKING
WASHINGTON, Jun. 18, 2007 (AP Online delivered by Newstex) -- As Congress edges closer to renewing a health insurance program for children, state officials have made it clear that they have a much different vision for the program's future than the Bush administration.
Governors and Medicaid directors have put their weight behind a bill that would more than triple funding for the program _ from about $5 billion a year to more than $15 billion. This would allow them to reach out to 5.5 million uninsured children presumed eligible for government health insurance based on their incomes. Plus, they could continue to provide health insurance to populations whose incomes are above the threshold the program was originally designed to serve.
The Bush administration would like to return the program to its original roots _ children whose families earn too much for Medicaid but not more than twice the poverty level. Today, that threshold is $41,300 for a family of four.
More than a dozen states now allow participation by children whose family income is above that threshold.
The first test for those competing visions will occur later this month when the Senate Finance Committee takes up the reauthorization of the State Children's Health Insurance Program, or SCHIP. In a recent letter to the committee, the National Governors Association said it was crucial that Congress give the states room to decide who the program should serve.
"I am committed to ensuring California leads the way in reducing the number of uninsured children," said Gov. Arnold Schwarzenegger, R-Calif., in a separate letter to Finance Committee leaders. "It is my goal to cover every uninsured child in California under 300 percent of the federal poverty limit using SCHIP funds."
California covers about one out of every six SCHIP recipients nationwide _ more than 1 million.
When Congress approved the children's insurance program in 1997, it provided $40 billion over 10 years. States use the grant money, along with their own dollars, to subsidize health coverage. On average, the federal government pays about 70 percent of the costs and states pay about 30 percent.
The Congressional Budget Office has said the best way to reduce the number of uninsured Americans is to target enrollment toward families with the lowest incomes. States have some ideas on that front, too. For example, they want lawmakers to do away with a provision that prevents children of state employees from participating in SCHIP programs.
The ban affects scores of entry-level employees who start at low salaries, as well as part-time and temporary employees, said Anthony D. Rodgers, who oversees Arizona's SCHIP program.
"That has got to be corrected," said Ann C. Kohler, director of New Jersey's SCHIP program. "I think this affects many children."
Another recommendation from the nation's governors is to let children of legal aliens enroll in SCHIP. When Congress overhauled the nation's welfare laws more than a decade ago, it barred coverage of such children for the first five years they are here.
Several states also are increasing their investment in improving enrollment rates for children already eligible for the program, but not yet signed up. They represent the majority of uninsured children in this country.
Andrew Allison, who oversees the Medicaid and SCHIP programs in Kansas, said that state's legislature recently approved $300,000 to enroll children already eligible for government-subsidized coverage. When Congress reauthorizes the children's health insurance program, it will be determining how much matching funds would be available for such efforts.
Allison said that mass marketing of public health insurance is not an effective way to generate enrollment, so Kansas hopes to find eligible families at places such as public health clinics and hospital emergency rooms.
He said that families that don't qualify for cash assistance often assume they won't qualify for health insurance assistance.
"These programs change all the time, so you can imagine there would always be confusion," Allison said.
Rodgers said Arizona officials will propose $500,000 in state funding to generate more enrollment among already eligible families. He said it would help him make his case to that state's Legislature if Congress set aside some "prime-the-pump money."
"We have found when we talked to people, they just didn't know they qualified," Rodgers said, adding that many new enrollees are young families just getting started in their careers.
Sen. Charles Grassley, R-Iowa, said that setting aside enough money to help those already eligible for the program has much support from lawmakers in both parties. Where differences occur is whether the program should cover those above 200 percent of the poverty level and some adults.
Lawmakers may allow those adults already in the program to keep their coverage, but could prevent the administration from granting future waivers that lets states cover adults, he said.
"This administration has made it possible for this to be a convoluted program through waivers," Grassley said. "There's probably people who shouldn't be covered who are covered."
"If adults are included, it needs to be called something else," said Sen. Kent Conrad, D-N.D.
Some of the waivers allowing adults into the program were granted when Mark McClellan served as the administrator for the Centers for Medicare and Medicaid Services.
"They were done on my watch," said McClellan, now with the AEI-Brookings Joint Center for Regulatory Studies. "In support of that approach, there is no question that covering kids with their parents is more efficient overall. It's a better way to provide coverage than to have separate plans for kids and parents."
New Jersey will push for Congress to let it continue to cover adults as well as children whose families earn below 350 percent of poverty _ about $72,000 for a family of four. Kohler said that it costs more to live in New Jersey than the great majority of states, and Congress should consider such regional differences rather than apply a uniform limit to all.
"In New Jersey, with the high cost of living, certainly these are not rich families," Kohler said.
The biggest sticking point over the coming weeks will be money. Democrats want to spend $75 billion on SCHIP over the coming five years. The Bush administration has recommended $30 billion. That amount does not include about $4 billion left over from SCHIP's first 10 years.
Lawmakers will attempt to find new sources of revenue or cut other programs to help pay for the health insurance program's renewal. The two potential sources of funding most frequently discussed are an increase in the federal tobacco tax as well as lower payments to certain insurers covering the elderly and disabled in Medicare.
Newstex ID: AP-0001-17532226
