Let’s Make Health Care Reform Work For Low-Income Children

December 11, 2009

As I wrote awhile ago, the current health care reform bills could leave many low-income children worse off than they are now. The children at risk are some portion of those who are currently enrolled–and others others who should be enrolled–in the State Children’s Health Insurance Program.

Those whose families are poor enough will have a broad range of very low-cost benefits through Medicaid. Not-quite-so-poor children now enrolled in SCHIP will be shifted to the health insurance exchange–immediately under the bill the House passed and in 2013 under the bill the Senate is debating. And that’s where the problems lie.

Plans purchsed through the exchange will have considerably higher premiums and out-of-pocket costs. And neither the House nor the Senate bill requires them to cover all the health services children need.

Moreover, just because the Senate bill would temporarily extend SCHIP doesn’t mean that all eligible children would be covered. According to a Kaiser Family Foundation brief, most of the 8.9 million children without insurance now are eligible for a public health care program. The Congressional Budget Office estimates that SCHIP and Medicaid combined will cover only 5.6 million more children in 2013.

Nor does the current Senate bill mean that children in SCHIP will get adequate health care. The Children’s Defense Fund has called the current system “an unjust lottery of geography”–in part because some states operate SCHIP programs that offer less than the comprehensive screening, prevention, diagnosis and treatment services available under Medicaid.

Senator Bob Casey (D-PA) has introduced an amendment (#2790) that would address these problems. As his summary indicates, it would:

  • Continue federal funding for SCHIP through 2019.
  • Require the U.S. Department of Health and Human Services to report on differences between coverage under subsidized plans in the exchange and coverage under SCHIP, thus giving Congress a basis for deciding whether to preserve SCHIP beyond 2019.
  • Require states to offer the same range of services to children in SCHIP as they cover under Medicaid.
  • Provide federal matching funds for all covered services SCHIP children receive instead of giving states a predetermined grant for each year.
  • Prohibit states from reducing income eligibility standards for SCHIP and require them to cover all children up to 250% of the federal poverty line, beginning in 2014.
  • Ensure that SCHIP remains affordable by prohibiting states from increasing charges, except to reflect increases in the median income for low-income families.
  • Provide grants and a significant financial incentive for states to increase outreach and streamline theirĀ  enrollment process.

Voices for America’s Children has a customizable e-mail that those who have Senators can use to support this worthy amendment. We who live in Washington, D.C. can call or e-mail Senate Majority Leader Harry Reid, since he will reportedly will incorporate changes he likes into a final manager’s amendment.

The leadership is pushing to get something passed before Christmas. So time is of the essence here.


Low-Income Children Could Be Worse Off After Health Care Reform

November 7, 2009

Last Wednesday, hundreds of concerned citizens answered the Children’s Defense Fund’s call to join a “stroller brigade” to the U.S. Capitol. Other brigades strolled in at least 16 communities across the U.S.

These brigades were to demonstrate grassroots support for “comprehensive, affordable, accessible health care for all children, no matter where they live.” This is by no means an inevitable result of federal health care reform.

CDF warns that the health care reform bills Congress is debating give short shrift to the needs of millions of uninsured and under-insured poor and near-poor children. They could, in fact, leave many worse off than they are now.

CDF and the “champions for children” it’s organized want Congress to do three things.

1. Guarantee all children access to the full range of health benefits they need, i.e., the early and periodic screening, prevention, diagnosis and treatment (EPSPDT) services children can get under Medicaid. There are four related concerns here.

  • Only some children enrolled in the State Children’s Health Insurance Program (SCHIP) get comparable benefits because states can offer more limited coverage.
  • Under the bills now pending, children whose families purchase insurance through the newly-created exchange will not be covered for all EPSPDT services.
  • These children will eventually include those enrolled in SCHIP. The bill the House will vote on would sunset the program in 2013. The final Senate bill will probably extend it to 2019. But even before then, SCHIP children will be shifted to the exchange if a state runs out of funds for the program.
  • Premiums and out-of-pocket costs in exchange plans will be higher than what families pay under SCHIP. As a study for First Focus shows, the difference could be as great as 33%.

2. Eliminate the unjust lottery of geography. Here again, the problem is that SCHIP benefits and eligibility vary from state to state. In some states, SCHIP is structured as an expansion of Medicaid, thus ensuring EPSPDT benefits. Other states have separate, more limited programs. Twenty-two states permit enrollment of children up to 300% of the federal poverty line. The eligibility cap in the remainder is lower.

So what CHN wants in the final health care reform package is mandatory coverage under SCHIP for all children under 300% of the FPL, federal funding to ensure states can enroll all eligible children and, I infer, a nationwide benefits standard comparable to EPSPDT. It also wants SCHIP retained until the alternative can be shown to provide coverage at least as good.

3. Address bureaucratic barriers that keep children eligible for Medicaid or SCHIP from getting the care they’re entitled to. CHN says that complex application and enrollment processes and frequent renewal requirements now keep about two-thirds of eligible children out of these programs. It wants Congress to require a simple, streamlined process.

Those of us who didn’t stroll can support CHN’s agenda by signing on to its letter to Members of Congress.

As Washington Post columnist Harold Meyerson observes, “children–most particularly, children of non-affluent parents–have no clout whatever in the political process.” They depend on us and venerable champions for children like CHN.

Children’s Health Insurance Update

January 22, 2009

As expected, the U.S. House of Representatives passed its version of the State Children’s Health Insurance Program (SCHIP) reauthorization. The vote was 289-139, with 40 Republican voting in favor and two Democrats against.

The Senate Finance Committee completed work on the Senate version last Thursday. It added the House-passed provision that would allow states to immediately provide coverage to immigrant children and pregnant women who are in this country legally. It also added an option for states to provide dental care coverage for children who don’t have it through private insurance.

Now the full Senate will begin consideration of the SCHIP bill, possibly as early as today. Though Democrats are in a majority, passage is not a slam-dunk. The Republican leadership is strongly opposed to the current version of the bill. This means we are likely to see proposed amendments to narrow it.

Based on what Republican leaders have said, I’m guessing these could include:

  • Elimination of the legal immigrant children and pregnant women option
  • Reduction of income eligibiity from 300% to 200% of the federal poverty level
  • More onerous citizenship verification requirements
  • A provision designed to prevent “crowd out,” i.e., parents switching from private health insurance to SCHIP

The Democrats have the votes to defeat such amendments. But under Senate rules, they will need at least five Republicans to join them in voting to end debate. Without those votes, there can be no vote on the SCHIP bill itself.

Maybe those five votes are already there. If they aren’t, then the SCHIP bill could be weakened to get them.

So those of you who want to see SCHIP significantly expanded should consider contacting your Senators, especially if either or both are Republicans. The toll-free hotline is still open. It’sĀ 1-800-828-0498.

Support Health Coverage for Uninsured Children

January 14, 2009

The Coalition on Human Needs has issued an urgent action alert to mobilize public support for reauthorization of the State Children’s Health Insurance Program (SCHIP).

SCHIP provides health insurance for children of working families who earn too much to qualify for Medicare but not enough to afford private health insurance. It had to be temporarily extended last year because President Bush twice vetoed an expansion that would have covered an additional 4.1 million children–most of them already eligible for coverage.

Expansion is more urgent than ever. CHN says that more than a million more children are now uninsured because their parents have been laid off and so no longer have employer-sponsored health insurance.

Congress has decided to put SCHIP expansion at the top of its action agenda, knowing it will not again be vetoed. And the votes seem to be there. But more is needed than a higher level of authorized funding.

Under current law, immigrant children and pregnant women who are legally in this country must wait five years to become eligible for Medicaid and SCHIP. The bill in the House of Representatives would allow states to eliminate this discriminatory waiting period. The current Senate bill would not.

The House is likely to pass its version of SCHIP reauthorization today. The Senate will begin considering its version soon. So those who want SCHIP expanded and legal immigrant children treated equitably need to contact their Senators ASAP. (Or course, those of us who live in D.C. have no voting Senators to influence. But that’s an issue for another day.)

For the rest of you, there’s a toll-free hotline to the Capitol Hill switchboard. Just call 1-800-828-0498 and ask to be put through to each of your Senator’s offices. Two quick, free calls could make a big difference for children’s health.