At the moment, nearly everyone interested in the S-CHIP debate is focusing on October 18, the
day the US House of Representatives will try to override the President’s veto of an expanded State Children’s Health Insurance Program (SCHIP).
Unlike many of the critics, I favor the expanded program. Briefly, here are a few things to
keep in mind:
First, under the proposal, 70% to 80% of children in the program would be from
families earning less than twice the poverty level ($20,650 for a family
of four earning up to $60,000 a year would qualify for the program
in most states. But given the fact that the average annual premium for
family coverage is now pushing $13,000, it is not at all unreasonable
to suggest that families earning $$60,000 before taxes cannot
afford private insurance.
maybe these families could buy private insurance just for their children,
but it’s hard enough to buy individual coverage (when you don’t
belong to a group) –try finding individual insurance that covers
As for the
notion that families who now have coverage from their employer will
take their children off private insurance and put them on SCHIP—this
ignores the fact that when you have coverage in your workplace, the
additional amount that you pay for your children is quite small. Insuring
kids is cheap. So many people would probably keep their kids on their
employers’ insurance and avoid the administrative hassles of enrolling
of the expansion point out that New York State want to expand coverage
to families earning up to $82,000 a year (but only if the Health and
Human Services Department approves a waiver). To someone living in Mississippi
$82,000 no doubt sounds like a handsome sum. But anyone living in the
greater NYC area knows how hard it is to house, feed and clothe a family
of four on $82,000—before paying federal, state and NYC taxes. Moreover,
SCHIP is not free. Families must pay co-premiums.
With these facts in mind, I hope the House can override the President’s
But even if it the veto stands, this does not mean that Congress has
to give up on insuring poor children. Below, an excerpt from I piece
that I wrote for The Guardian’s “Comment is Free.” It was published on
September 27, and focuses on how easy it is to bump children from SCHIP
and Medicaid. If we can’t expand Schip, at least we should do everything
we can to keep kids who are already in these programs enrolled.
In July, Health
Affairs published an article explaining "Why millions
of children eligible for Medicaid and S-Chip are uninsured". The author, Benjamin
Sommers, a resident in internal medicine and primary care at Brigham
and Women’s Hospital in Boston also has a Ph.D. in health policy, and
has published widely in medical journals.
that, in 2005, 74% of all uninsured children were eligible for public
coverage, but were not enrolled. Many people assume that this is because
parents didn’t know about the programs, or just didn’t bother to sign
up. But the truth is that even if you enroll, it’s easy to be dropped
from the program.
do not complete the eligibility renewal process, which occurs once or
twice annually depending on the state, then their children ‘disenroll’
– a loss of coverage that is often completely unintentional," Sommers
The study found
that 34.1% of children insured under Medicaid or S-Chip lost their coverage
by the following year, despite remaining eligible. During that time,
"states took steps that intentionally or unintentionally exacerbated
dropout", Sommers reports.
For one, "the
majority of states have established separate S-Chip programs rather
than using S-Chip funds to expand their existing Medicaid programs.
… Running a separate program – a more complex administrative structure
– has been linked to significantly higher dropout rates. Furthermore,
several states have responded to budget difficulties by making the renewal
process more cumbersome or by increasing S-Chip premiums, both of which
may exacerbate dropout."
The trend is
likely to accelerate, Sommers says, because of a 2006 federal regulation
requiring increased citizenship documentation for Medicaid renewal.
Simplify the renewal process, requiring renewal only once a year, and
use the same application forms for both S-Chip and Medicaid. Another
option is "passive enrollment, in which families are required to
submit paperwork only if their circumstances have greatly changed in
the previous year. Otherwise, children are assumed to still be eligible
as long as parents continue paying premiums. A similar approach for
children in Medicaid is to send preprinted forms completed with the
prior year’s information, which parents can simply sign and return,
as long as their circumstances have remained the same."
While the expansion of S-Chip to include even more children may not be possible, given Bush’s
intransigence, legislators should not give up on the issue. Helping
those who are already eligible from being stripped of coverage would
be a good place to start.