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.
John McDonough
Give me a break. What good is it to help children with health insurance when their parents, and other relatives, as well as childcare workers, teachers etc. who used to be “middle class” cannot barely afford mortgages, rent, food, utilities and gasoline—let alone any insurance at all? Parents and caretakers etc. get sick, go to emergency rooms, and sometimes die. So, who is going to take care of these healthy children when the parents, caretakers, etc. are still becoming ill? Some people cannot afford their own insurance, how can they afford extra taxes to subsidize their own and/or other people’s children’s insurance?
How about all the US Representatives, Senators, and some other Federal and State government employees and their spouses along with the 10% of the wealthiest in US give up some of their lucrative salaries, company cars, retirement packages,tax benefits, NAFTA salary savings, paid-for stock options, and government contracts etc. Let them also agree to work just two weeks a year at minimum wage to “help out” children’s health care.
Actually children’s health care is just another part of the shell game we are continually subjected to by our elected officials and some biased news media. Children’s healthcare is just the tip of the iceberg of the many US problems, and crisises that have been going on here for years.
This whole schip debate has become ludicrous in the midst of the looming presidential election.
So 250% of poverty level isn’t enough for Dems, they way 400%, Thats right a family of 4 making $80,000 can get uncle same to fund their childrens health care.
Sounds like a step towards universal socialized medicine to me.
I am, and always have been, very ambivalent about the SHIP/CHIP program. Excluding the unique situation of Massachusetts from the analysis, the SCHIP/CHIP issue is troubling.
This “but its for the kids” garbage gets awfully old awfully fast.
It is true that the high-cost states were the ones pushing extending eligibility to up to 400% Federal Poverty Level, ie: $96,520 for a family of 5, $82, 600 for a family of 4, $68,600 for a family of 3, and $54,760 for a family of 2. In NYC, DC, LA and San Francisco, even those incomes are priced out of buying a house and are looking at insane amounts for rent such as $2000 or more for a 2 bedroom apartment. However, that is a localized problem. The problem may exist in NYC but it sure doesn’t exist in Buffalo, NY. A rule for all the country, or even all of a state such as NY, can not be tailored to satisfy a problem for a small minority. If NY is so concerned that the outrageous cost of living in NYC keeps families from being able to insure their kids, it can come up with all the money to insure that upper income demographic.
As written, the bill set a limit of 300% Federal Poverty level ($72,390 for a family of 5, $61,950 for a family of 4, $51,450 for a family of 3, and $41,070 for a family of 2.) In the vast majority of the US, those are high incomes with a great deal of spending power. Buying the median priced house in the US takes an income of $60,000+/-. To put it in perspective, the median household in the US has 2.59 people and an income of $48,201 in 2006. That puts the median household of 2.59 people at 306% of Federal Poverty Level. A $61,000 household income is in the top 34.09% of all incomes in the US; and a $72,000 income is in the top 24.13% of the US. Not exactly the middle class (which is those at the lower 40th percentile to those at the 60th percentile – not those at the 66% and up) but edging into the upper middle class.
The median household income in NY is $51,384 and the median family income is $62,138. A rough calculation shows that as many as 62% of all family households in NY would be eligible. That is a LOT of households that would fall in class of probably being eligible. If a household can not manage on that $54K, $68K, $82K or $96K and above because they live in a high cost area, they seriously need to consider moving!
Yes, healthcare is extremely expensive. At the average of $12,000 for a non-group family policy, as a % of income for a family at 400% FPL, that would be 22% for a family of 2; 17 ½% for a family of 3; 14 ½% for a family of 4; and 12 2/5% for a family of 5. On the other hand, the Massachusetts system requires a 55 year old individual making $50,001 to shell out around $4500 in premiums with a $2000 deductible and total out-of-pockets up to $5000 – and that would be 19% of their income; and a couple in the same age group with a $80,001 income is looking at premiums around $9000 with a $4000 deductible and OOPs of $10,000 – and that would be 23 ¾% of their income.
It should be emphasized that to insure the children in a household does NOT, however, require purchasing coverage for the parents as well. Children are the least costly group to insure as they are the least likely to need healthcare. Most children-only policies run from $100 –150 a month per child. That would be $1200 – 1800 a year. For a single parent household and one child with a $41,000 income, that is only 3 2/3rd% of gross income. For a singe parent with 2 children and an income of $51,000, the premiums would be about $3000 and 5 5/6% of gross income. For a 2 parent/1 child household with an income of $51,000, the premiums would be 2 11/12% of gross income. These costs are hardly a burden if the sole goal is to insure children and let the adults (including parents) take their chances without coverage.
As far as the ‘but it’s the kids” tedious refrain goes, tough. They can suffer along with the rest of us who can’t afford coverage. Children are the least likely demographic to need healthcare and thus the cheapest to insure. They are far, far, far less likely to die from treatable conditions if they can not access healthcare. The 18,000 who die every year from treatable conditions because they do not have coverage and can not pay for care are adults well over 99% of the time. So cry me a river about the poor kids – I’m waiting for someone to be equally concerned about the 40 year old woman with cancer who can not afford care or the 52 year old man who needs a bypass and who will die from lack of care.
And don’t bother with the “compassion” argument. As a society, we are prepared to let those who are disabled try to survive on $600 a month from Social Security Supplemental Income (born disabled or became disabled before working enough) or an average of $800 from Social Security Disability. That is all they have to pay their housing, utilities, transportation, medical copays and deductibles, and nearly all their food (given the weird was Food Stamps are calculated.) In comparison, I can’t get to worried about a kid whose parents make $70,000 and have to pay out of pocket for an office visit.
And forget Iraq as a source of funding. That whole dog and pony show is on a credit card.
Bush – philosophical divide – from NY Times – 10/3/07
“It is estimated that if this program were to become law, one out of every three persons that would subscribe to the new expanded Schip would leave private insurance,” the president said. “The policies of the government ought to be to help poor children and to focus on poor children, and the policies of the government ought to be to help people find private insurance, not federal coverage. And that’s where the philosophical divide comes in.”
Heaven forbid that the government should “crowd out” big business insurance companies. That’s what it’s all about. Look familiar, Massachusetts?