Transcript Federal Child Health Issues: Looking Forward, Looking Backward Jocelyn Guyer Center for Children and Families Colleen Chapman Spitfire Strategies.

Federal Child Health Issues:
Looking Forward,
Looking Backward
Jocelyn Guyer
Center for Children and Families
Colleen Chapman
Spitfire Strategies
WHAT HAPPENED?
SCHIP Reauthorization
2007: Wave of Support
for SCHIP Reauthorization
Americans Support Covering Children
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
Over 400 Positive
Editorials and Headlines
Final SCHIP Bill
• Coverage for an additional 4 million uninsured children
• $35 billion in funding over 5 years
• Major new initiatives to reach already eligible but uninsured
Medicaid children
• New child health quality initiative
BUT
• No new option to cover legal immigrant children and pregnant
women
• New limitations on covering moderate-income children
• Phasing out of adult coverage
• Improvements for citizenship documentation requirements,
but also applied to SCHIP
Two Perspectives from Republicans in
Iowa
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decompressor
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Representative Steve King (R-Iowa) on the House Floor, 10/18/07
Two Perspectives from Republicans in
Iowa (continued)
“This is a bipartisan compromise. It
has broad support from
Republicans and Democrats. It will
help as many as 4 million low
income uninsured children…It puts
the lowest income children first in
line… Here's what it's not: It's not a
government takeover of the health
system. It does not undermine
immigration policy. It's not
expanding the program to cover
high income kids.”
— Senator Charles Grassley (RIowa) on the Senate Floor, 9/27/07
A Large Majority of Congress Supported
The Reauthorization Bill
(Vote on first major SCHIP reauthorization bill)
332
67
Senate
House
188
29
265
159
13
Support
Oppose
4
9
Prese nt/Not Voting
Source: Roll No. 906 in the House of Representatives (September 25, 2007) and Record Vote No. 353 in the Senate (September 27,
2007) which sent H.R. 976, the Children's Health Insurance Program Reauthorization Act of 2007, to President Bush who vetoed it on
October 3, 2007.
Bush - Why I Vetoed
Children’s Health Care
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decompressor
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August 17th Directive
• Issued August 17th, 2007
without notice
• In effect, makes it difficult
or impossible for states to
cover more moderateincome children
– 95% coverage rate
– Minimal decline in employerbased coverage
• Major shift in longstanding
SCHIP policy and quickly a
target for litigation
SCHIP Extension - S. 2499
• Extended SCHIP
through March 31, 2009
• Significant new funding
for many states
• Did not address the
August 17th directive
WHERE ARE WE NOW?
Federal Child Health Issues in 2008
• SCHIP reauthorization likely on the
back
burner until the fall
• Administration using administrative
strategies
to cut Medicaid and SCHIP
– Medicaid regulations
– August 17th SCHIP directive
• 6 of the 7 Medicaid regulations have been stopped,
but the directive remains in effect
Update on the Directive
• May 7th Clarifying Letter
• Medicaid expansion states are not subject
to the directive
• A moratorium on the directive was
included in the Labor, HHS Appropriations
bill, but not likely to pass until after August
Update on the Directive (continued)
• On May 9, 2008, Rhode Island
became the first state to meet the
requirements of the August 17th
directive
• Serious questions have arisen
about Rhode Island’s data
“adjustments”
Update on the Directive (continued)
“We said they moved the goal-line for RI
(by shifting from a 95% enrollment of
eligibles to 95% insurance coverage).
Now, we see they ignored a fumble,
overturned an interception, gave them
two extra downs - and still had to move
the goalposts!”
- State official from another state
commenting on Rhode Island’s approval
At Least 22 States Are Affected by the
“August 17th” CMS Directive
WA
NH
VT
MT
ND
OR
ME
MN
ID
WY
NV
UT
NY
MI
IA
NE
CA
MA
WI
SD
PA
IL
CO
KS
OH
IN
WV
MO
VA
KY
NC
AZ
AK
OK
NM
TN
AR
AL
DC
GA
LA
HI
States already
negatively impacted
(8 states)
NJ
DE
MD
SC
MS
TX
RI
CT
FL
Expansion states with
2008 implementation
dates (3 states)
States with approved plans
that must comply by August
2008 (12 states)
States deemed by CMS to
meet the directive
requirements (1 state - RI)
Note: DC covers children above 250% FPL, but because they are a Medicaid expansion state, they are not affected by the directive.
Ohio is also a Medicaid expansion state, but they delayed implementation of their eligibility expansion due to the directive.
Source: Center for Children and Families, July 2008.
LOOKING AHEAD
Key Questions for the Future
• How will SCHIP
reauthorization get done?
• Will we have national health
reform?
• What administrative actions
might a new Administration
take to quickly improve
coverage for children?
Under an Obama Administration
Options for SCHIP
1. Push for quick
reauthorization of SCHIP;
pursue more ambitious
children’s agenda in health
reform
2. Hold SCHIP for the larger
health reform debate
Under a McCain Administration
Options for SCHIP
1. Push for quick action on
SCHIP
2. Shoot for a more
ambitious SCHIP bill given
broader reform is unlikely
Obama on SCHIP
“If there’s one thing all
of us should be able
to agree on, no matter
what our political
views, it’s that our
children should get
the treatment they
need when they need
it. And when I’m
president, they will.”
Source: Barack Obama’s comments on Bush’s veto of SCHIP, October 3, 2007.
McCain on SCHIP
QuickTime™ and a
decompressor
are needed to see this picture.
Talking Points on SCHIP Reauthorization: Background
Considerations
• Serious harm to children if reauthorization drags on
• SCHIP reauthorization is a first step, not a final step, for children’s
coverage.
• Despite fears to the contrary, SCHIP reauthorization can help pave
the way for broader reform
• Reauthorization should be as strong as possible but overreaching is
a risk
The Imperative for Quick Action
on SCHIP
Given that SCHIP will expire early in the term of the
new President, quick, decisive action on
reauthorization will be critical.
• A strong, reauthorization is needed to continue
coverage for millions of low-income children,
especially because it will take some time for
broader health reform to be acted upon and
implemented
The Imperative for Quick Action
on SCHIP
Given that SCHIP will expire early in the term of the
new President, quick, decisive action on
reauthorization will be critical.
• An early win on SCHIP will show that the new
Congress and new Administration can start to
break the gridlock of the Bush years.
The Imperative for Quick Action
on SCHIP
Given that SCHIP will expire early in the term of the
new President, quick, decisive action on
reauthorization will be critical.
• By taking action on common sense, bi-partisan
legislation, the new Congress and Administration
can start a working relationship that will pave the
way for broader reform.
The Imperative for Quick Action
on SCHIP
A series of short-term SCHIP extensions would
wreak havoc with children’s coverage
• States will be paralyzed in their efforts to move forward
• With the economic downturn causing more families than
ever to need affordable coverage for their children, it is
exactly the wrong time to introduce massive uncertainty
into the future of SCHIP
• A series of extensions will drain time and energy away
from other initiatives, such as broader health reform
The Imperative for Quick Action
on SCHIP
Even after SCHIP
reauthorization, the job
will not be finished. As part
of broader reform:
• All children in America
should have coverage.
• All children should have
access to the care they need
to grow and develop.
Broader Health Reform –
What Do Children Need?
• Access to affordable coverage for all
children
• Stronger financing structure
– Shortcomings of Medicaid’s financing
structure
– Capped funding in SCHIP
• A benefit package designed for
children and their unique
developmental needs
• High quality care with access to
needed providers
• Family-based coverage
Broader Health Reform –
Risk Points for Children
• Elimination of SCHIP/Medicaid
without an adequate replacement
• Failure to acknowledge and address
the unique needs of children
• Politicians using mandates to claim
victory on enrollment issues
• Poor coordination between existing
programs and new initiatives
• Fracturing of coverage within
families
Administrative Actions to Quickly
Help Children
• August 17th Directive
• Medicaid Regulations
• Revamping Waiver/
Deficit Reduction Act
State Plan Amendment
Process