Today is the final day of the first 10 years of the State Children’s Health Insurance Program (SCHIP – though House Democrats now insist it be called CHIP). Congress and the President have yet to agree on a new authorization – it’s being extended through mid-November by a continuing resolution, so hold the panic. So a few anniversary reflections.
SCHIP was created in 1997 as part of a much larger bill, the Balanced Budget Act. In early ’97, “smart” people said there was no way a Republican Congress would create a new social program in a year of deficit reduction. They underestimated the team of Senators Kennedy and Hatch who refused to give up and got it done .
When SCHIP was created, there were about 10 million uninsured kids; today there are between 5-6 million kids in SCHIP and about 10 million uninsured kids. Huh? What’s going on? Several things. First, many employers are dropping dependent coverage just as they are dropping retiree coverage and health insurance for their workers. Would they drop as quickly if SCHIP were not around? Well, they were dropping before SCHIP. Most likely, some yes and some no. Second, the numbers of uninsured keep rising, including kids. Estimates are between a quarter and a half of kids on SCHIP had prior employer coverage.
The prevailing belief is that a large portion – as many as six million – of the 10 million still uninsured kids are eligible for their state SCHIP programs and unenrolled. Most states are reluctant to go gang-buster on enrollment because federal SCHIP dollars to states are capped, and most states are at or near their limits. Without significant new dollars, states won’t have enough money even to pay for kids currently on. The extra money in the new legislation mostly allows states to pay for enrolling kids who are eligible now under current rules.
Overwhelmingly, SCHIP kids live in families with incomes under 200% of the federal poverty line. Some states have gone up – Massachusetts up to 300%fpl – reflecting the higher cost of living that makes insurance unaffordable for families at higher income levels. The number of states over 300% is tiny, and the legislation Bush says he will veto actually would make it harder for states to expand to these higher levels.
Bush’s belligerence to SCHIP seems to reflect a growing deathwish on the part of the national Republican Party. After seven years of untold billions in waste, to draw a line in the sand on health insurance for lower income kids makes sense only from dark recesses of the political fringe. And once again, we can only shake our heads and laugh seeing Mitt Romney oppose legislation to facilitate what he happily signed (no veto pen here) in Chapter 58.
Ultimately, Bush will lose this one. He’s even done SCHIP a favor. SCHIP has gotten more publicity recently than at any point in its 10 year history. This will only enhance long term prospects for the program and give Americans one more compelling reason to vote out office those whose ideological blinders leave them unable to see uninsured kids.
By the way, click here for the New England Alliance for Children’s Health, run by our colleagues at Community Catalyst, and doing first rate work on SCHIP.