Transcript Document

Getting to the Finish Line on
Children’s Coverage
Getting to the Finish Line on
Children’s Coverage
Cindy Mann
Center 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
Setting the Context
• State economic conditions
• State actions
• Federal actions
State Budget Woes Worsening
FY 2009
WA
MT
VT
ND
OR
MN
ID
WY
AZ
CO
IL
KS
OK
NM
TX
IN
MO
PA
OH
KY
WV
AR
AL
VA
NJ
DE
MD
NC
TN
MS
AK
MA
NY
IA
NE
UT
ME
MI
NV
CA
WI
SD
NH
SC
GA
LA
FL
HI
States with Budget Shortfalls in FY09
(30, including DC)
States with Additional Mid-Year
Shortfalls (13 states)
Source: E. McNichol and I. Lav, “State Budget Troubles Worsen,” Center on Budget and Policy Priorities (September 8, 2008).
DC
RI
CT
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)
States Moving Forward
2008
WA
MT
VT
ND
OR
MN
ID
WY
NV
UT
AZ
MA
NY
IA
CO
IL
KS
OK
NM
IN
MO
TX
PA
OH
KY
WV
AR
AL
VA
NJ
DE
MD
NC
TN
MS
AK
ME
MI
NE
CA
WI
SD
NH
RI
CT
DC
SC
GA
LA
FL
HI
Enacted New Legislation/Took
Administrative Action to Improve Child and
Family Coverage (10 states)
Implemented 2007 Legislation to Improve
Child and Family Coverage (15 states)
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 Forward
• In 2008, 19 states authorized new
measures or implemented measures
approved in 2007
• Continues a 4-year trend: since 2005, twothirds 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
Reaching the Eligible but
Unenrolled Children
Procedural closings in Louisiana:
< 1%
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
114.1%
120%
101.8%
100%
87.4%
80%
71.6%
54.3%
60%
35.5%
40%
20.0%
20%
8.2%
4.0%
6.8%
9.3%
11.6%
14.2%
17.7%
22.7%
27.0%
0%
1999 2000
2001 2002 2003 2004 2005
Health Insurance Premiums
2006 2007
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
STATE
Total New
Enrollment
Previously
Eligible
Illinois
244,700
165,600 (68%)
Data from November 2005 - June 2008
Massachusetts
51,000
32,750
(64%)
11,000
(59%)
40,881
(83%)
Data from June 2006 - June 2008
Pennsylvania
19,000
Data from February 2007 - June 2008
Wisconsin
49,108
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
Missed Opportunity: CHIPRA
Was Projected to Help States Cover Nearly
4 Million Additional Children
3.8 Million Otherwise Uninsured Children
600,000
84% Eligible
Under
Current
Program
Rules
2,500,000
700,000
Children Newly Eligible
Through SCHIP
Expansions
Uninsured
Children Already
Eligible
Children Currently in SCHIP
Who Could Lose Coverage
Ne w Children's Enrollment in SCHIP & M edicaid
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).
What Happens on March 31, 2009?
Number of States that Will Face
Funding Shortfalls in FY 09
42
28
No SCHIP Bill
Extension with Level
Funding
Source: C. Peterson, “What Happens to SCHIP After March 31, 2009?,” Congressional Research Service
(July 22, 2008).
Emily is Waiting
The Imperative for SCHIP
Reauthorization
• 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
Americans Support Covering Children
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)