What to Watch for in Health Legislation: Reauthorizing SCHIP The health agenda for the 110th United States Congress is expected to be crowded, and reauthorization of the State Children’s Health Insurance Program (SCHIP) is high on the list of issues that will loom large in the coming year, according to a report released in December by a group of organizations active in children’s health care. SCHIP, a law that Congress passed initially in 1997, which provides federal funding to states for programs to insure children whose family incomes are too high for Medicaid but too low to allow them to buy health insurance is scheduled to expire in September this year. In the report, “Too Close to Turn Back: Covering America’s Children,” the American Academy of Pediatrics, the March of Dimes, and the National Association of Children’s Hospitals outlined the key issues Congress must address in the SCHIP reauthorization. But before dealing with SCHIP, the groups pointed out, it’s important to remember that SCHIP “stands on the shoulders of Medicaid,” since SCHIP insures children whose family incomes are too high to qualify for Medicaid. That makes it imperative to keep Medicaid strong, whatever else happens in the coming year, the report says. For SCHIP itself, described as “the most successful health care reform Congress has undertaken in the last 10 years,” the report cites three important areas Congress needs to address. They are:
Funding As one of its last acts in the congressional session that ended in December 2006, Congress agreed to redistribute currently unused federal SCHIP funds from states that did not use them to states that are experiencing funding shortfalls. But that is a temporary expedient, and more long-reaching problems exist, including the fact that SCHIP programs have grown since 2002 to the point that a difference of more than a billion dollars is predicted in 2007 between the amounts states will need to operate their SCHIP programs and the allotments they will get from the federal government. As the law stands now, states must spend some of their own money on SCHIP, but the federal government contributes from 65 percent to 85 percent, depending on the state, a considerably higher share than it pays for Medicaid. Unlike Medicaid, however, the amount that a state can draw down for SCHIP is capped and is divided among states according to allotments determined each year by a formula that takes into account a state’s share of low-income children and its numbers of uninsured low-income children. States may use their SCHIP funds to expand Medicaid or to cover children in separate non-Medicaid child health programs. Currently, every state has a SCHIP program, with coverage available to families at 200 percent or more of the federal poverty level in 41 states and to families below the poverty level in 10 others states. States have broad flexibility to set SCHIP income eligibility levels. Access Currently, 19 percent of uninsured children are believed to be eligible for SCHIP, and approximately 70 percent of those eligible for SCHIP are enrolled. That still leaves a way to go before all children have health insurance, advocates say. They point to a poll of American voters conducted in November 2006 that found 56 percent of voters favor investing more money in SCHIP in order to increase the number of children who are covered. Another 26 percent of those polled said they would be willing to increase funding simply to assure that current coverage can continue. That’s 82 percent of the electorate, a number Congress should keep in mind when the time comes to authorize SCHIP, supporters say. The report urges Congress to eliminate barriers that keep eligible children from getting SCHIP coverage. Among suggested new approaches are offering performance-based assistance with coverage costs to states that succeed in covering all or large numbers of uninsured children. Surveys have also found that in many states enrollment requirements and paperwork need to be simplified and made culturally available. In many cases, families whose incomes make them eligible for SCHIP appear to avoid SCHIP because they lump it with Medicaid as a form of welfare. Assessing Quality of Care “In the nearly 10 years since enactment of SCHIP, the world of quality and performance measures in health care has opened up dramatically,” said Lawrence McAndrews, president of the National Association of Children’s Hospitals. “However, there’s been little federal investment in quality and performance measures for children’s health care. It’s time to do that for kids, through both SCHIP and Medicaid.” The March of Dimes “strongly recommends” that the reauthorization bill include provisions to strengthen the quality of health care that SCHIP enrollees receive. Most national quality initiatives to date have focused on adults, but as children are developing, they have different health care needs than adults, and SCHIP would be an excellent vehicle for measuring pediatric quality, the March of Dimes says, possibly with the Agency for Healthcare Research and Quality (AHRQ) in the U.S. Department of Health and Human Services taking the lead in developing pediatric measures. The Center for Children and Families report, “Too Close to Turn Back: Covering America’s Children,” is available online at http://ccf.georgetown.edu. See also: |
