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Moving forward on SCHIP

The Senate passed its version of legislation to renew the State Children’s Health Insurance Program (SCHIP) Thursday, bringing the bill very close to its long overdue White House signing ceremony. The new bill is expected to cover an additional 4.1 million uninsured children by 2013.

Most importantly, the new bill – like the old ones vetoed by President Bush – gives states new funding to sustain and strengthen their SCHIP programs. This will occur just in time, as families hit by the economic downturn look for affordable coverage options. It also gives states new tools to reach already-eligible, uninsured children and provides them with performance-based incentives to enroll them.

I’m thrilled about this bill. Not because I think it will solve everything, but because it will offer concrete help to many kids who need it now and can’t wait until we figure out comprehensive health reform.

It is fair to say, however, that not everyone shares my joy.

The Senate debate over the bill turned ugly, with Sen. Pat Roberts (R-Kansas) shouting across the Senate floor that Democrats were “ruining SCHIP.” It was a ridiculous charge, especially because the heart of the moving forward – indeed, nearly all of the details – were taken from a bipartisan package put together by Senators Max Baucus, Charles Grassley, Jay Rockefeller and Orrin Hatch.

The one new, notable provision in this bill is a state option to eliminate a 5-year waiting period for coverage now applied to legal immigrant children and pregnant women. While I understand some members don’t like the idea, it was added through a fair and open process during mark up in the Senate Finance Committee on a vote of 12 to 7. And, many of the Senators who now consider it a deal-breaker, have actually voted for it before when it was part of the Medicare Modernization Act. It wasn’t a deal-breaker then and shouldn’t be one now, when it comes to children’s coverage.

As for next steps, House Majority Leader Nancy Pelosi said that the House of Representatives will quickly pass the Senate version of the SCHIP legislation, eliminating the need for a conference committee. This means it will be on President Obama’s desk in the next week or two.

Jocelyn Guyer is the deputy executive director at the Center for
Children and Families (CCF) and a senior researcher at the Georgetown
University Health Policy Institute. This post represents her personal
opinion not that of the Institute.

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11 replies »

  1. Anyone who thinks illegals wont be able to access this program is a fool. I keep hearing people say “Are you going to punish a 5 year old because his father is an illegal alien?” I’m not punishing him. If his father hadn’t brought him here in the first place then there would be no problem.
    Lets be perfectly clear on the moral argument here.
    It is not my fault there are children of illegal aliens in this country. It is the illegal alien’s fault. Thier unethical actions cannot create a moral dilemma for this country. Giving any benefits to people who are in this country illegally is unethical. If I decide I want to give charity to illegal aliens then I will do so. I personally think anyone who assists illegals should be arrested but that is neither here nor there. In order to provide charity you have to give of your own money, or else its not really charity, is it?
    Since the Government is giving away our money its not charity, its theft, wealth re-distribution and misappriation of funds. Governments can not be charitable since ITS NOT THIER MONEY!
    In this time of national bankruptcy the very idea of giving benefits of any kind, let alone expanding them, to people who shouldn’t be here is not only unethical its irresponsible and anyone who supported it should be impeached.
    Unfortunately the American populace is turning into sheep who will do whatever the government wants or says and not think about it more than once or twice before they turn American Idol back on and go back to thier Sudoku puzzle.

  2. every small business owner like me will be droping family coverage for employees tomorrow. i am meeting with my bcbs rep. next wk to discuss next years premiums without the children. none of my employees makes over 80k a year.

  3. More interesting facts on this great program;
    SCHIP’s great expense stems from the fact that in many cases, it simply enrolls children who were already insured privately. Economists Jonathan Gruber and Kosali Simon estimate that out of every ten children added to the SCHIP rolls, six already had private coverage. Only in government is a program deemed to “work” when it covers four uninsured children for the price of ten.
    The current proposal will only exacerbate this problem. Congressional Democrats want to expand SCHIP to children in families of four earning up to $80,000 per year. The Congressional Budget Office reports that 77 percent of such children already have private health insurance.
    One thing SCHIP does accomplish is to discourage work. SCHIP and similar programs create enormous disincentives to climb the economic ladder. A single mother of two earning minimum wage in New Mexico who increased her earnings by $30,000 would find no change in her net income: She would pay an additional $4,000 in taxes and lose $26,000 in SCHIP and other government benefits, according to data compiled by the Urban Institute for the federal government.

  4. Nate — The one new notable provision in the bill IS the state option to cover legal immigrant children. All of the other provisions were included in one or more earlier bills and supported by two-thirds of Senators. Those earlier bills were jointly crafted by Democrats and some leading Republicans.
    In my post, I wasn’t setting out to provide a comprehensive review of the complaints raised by the minority of Senators who opposed this bill on the Senate floor, but think you’ve done a nice job of doing that for those looking for this information.

  5. http://gop.gov/c/journal_articles/view_article_content?&groupId=1&articleId=1095&version=1.0
    The Congressional Budget Office, Congress’ official budget scorekeeper, estimated that Sec. 211 of the first version of H.R. 976 vetoed by the President would cost the federal taxpayer $3.7 billion over 10 years. Despite Democrat claims to have definitively prohibited illegal immigrants from receiving SCHIP benefits, the CBO cost estimate of Sec. 211 in the new version of the bill (CBO letter to Chairman Dingell, 10/24/07)
    The independent, nonpartisan Congressional Research Service and the Social Security Administration say that supplying a Social Security number, even a valid one, does not prove citizenship, and the Social Security Administration says it cannot verify if an SCHIP applicant is a citizen.
    Congressional Research Service: “A Social Security card (or having a valid SSN) does not denote citizenship, and is not useful for determining citizenship status. As discussed above, Social Security cards issued to noncitizens who are residing permanently in the United States are identical to those issued to U.S. citizens. In addition, aliens who are in the United States temporarily are also eligible for valid SSNs.” CRS Memorandum, 9/21/07)
    The nonpartisan Urban Institute estimates that more than 530,000 children already in families currently eligible for Medicaid or SCHIP (earning 200 percent of the federal poverty level or less) are not enrolled. In another study, the Urban Institute said “more than six in 10 uninsured children qualify for Medicaid or the State Children’s Health Insurance Program (SCHIP) but are not enrolled.”
    While these poor children remain uncovered, and despite Democrat claims to cap coverage at 300 percent poverty, the Congressional Budget Office estimates that the new version of the SCHIP bill will cost $500 million more over the next five years than the bill the President vetoed – $35.4 billion vs. $34.9 billion. (CBO letter to Chairman Dingell, 10/24/07 vs. 9/25/07)
    According to the independent Congressional Research Service, approximately 500,000 parents are currently enrolled in SCHIP. In fiscal year 2008, according to states’ own estimates submitted to the Centers for Medicare and Medicaid Services, 14 states will spend one-third of their total SCHIP funding on parents. Minnesota will spend 78 percent of its total SCHIP funds on parents. New Jersey, 55 percent. Illinois, 51 percent.
    This is no bill to be proud of

  6. I trust the words of a republican politician only slightly more then those of a Democrat and that’s zero. Hatch and the other 400+ of them need to pull their heads out of their back sides and address issues like this;
    HSS 2008 PERM
    “States receive a higher matching rate for SCHIP than for Medicaid, thus creating incentives for States to inappropriately enroll Medicaid-eligible children in SCHIP. Most recently, OIG found that an estimated 4 percent of children enrolled in separate SCHIP programs were eligible for Medicaid in 2006, representing an increase over the 1-percent error rate found in 2003. Additionally, 4.5 percent of cases lacked sufficient documentation to enable OIG to make a determination regarding Medicaid eligibility.”
    “Section 211 creates a state option to verify the citizenship status of citizen kids with the Social Security Administration using their SSN and date of birth.”
    How has this worked with employment? You can buy a SSN card on the corner in every major city. Is anyone really naive enough to believe identity thieves won’t be selling kids SSN and DOB 2 hours after the law passes?
    This is not rocket science or even an unknown problem. If the Democrats behind this bill, during a major financial crisis by the way, cared about insuring kids that can’t afford insurance why didn’t they take an extra hour and write a bill that actually did that? How does opening up another government program to additional abuse help insure kids?
    How is covering kids from families making 80K plus helping anything? This bill is not about covering uninsured kids it is another step to killing our private insurance system. Most people supporting this bill openly promote killing our current system which is their opinion but get off the high horse and call this bill what it is. Tax payors don’t need to be paying for 2 million+ kids to drop off private insurance and come on public rolls. Tax payors don’t need to be paying for insurance for illegal immigrants. Tax Payors don’t need to be paying extra taxes while the Feds blindly allow states to game the system.
    One simple line is all it would take;
    “Any enrollee who during tri-annual audit can not be substantiated will be retroactively terminated from Federal subsidy. The State will have future Federal subsidies reduced by an amount equal to the total Federal contribution for these enrollees.”
    Add my 3 lines and I guarantee you that 4.5% miss docs and 4% error rate will drop to next to nothing. Why couldn’t the Democrats do that if they sincerely care about the kids?
    “Apologies if I somehow suggested I was attempting to capture all of the Republican arguments against the SCHIP bill in my post.”
    “The one new, notable provision in this bill”
    You don’t find any of the other concerns voiced by Republicans, clearly on their website if you care to look, noteable? Or was this the one that could be spun to make Republicans look petty and uncaring?

  7. Thanks, Nate.
    The 4.1 million uninsured figure is from the Congressional Budget Office’s official score of the SCHIP bill. It reflects the number of otherwise uninsured kids who are expected to gain coverage by 2013 if this bill is signed into law. By this date, a total of 6.5 million children are expected to be covered as a result of the bill, but 2.4 million of them otherwise would have had private insurance. This is due to the much-discussed “crowd out effect,” which always occurs when you expand public programs. In this case, though, it has been characterized by the former Director of the Congressional Budget Office Peter Orszag when discussing the 2007 SCHIP reauthorization legislation as “pretty much as good as it is going to get.”
    Apologies if I somehow suggested I was attempting to capture all of the Republican arguments against the SCHIP bill in my post. Your addition certainly picks up accurately the tenor of the floor debate. Note, however, that Section 211 of the bill referred to in your post isn’t actually the same as the provision I was discussing that gives states the option to drop the 5-year waiting period for legal immigrant children. Instead, it refers to a provision designed to reduce the paperwork barrier imposed on citizen children (legal immigrant children face distinct documentation requirements) seeking coverage.
    Specifically, Section 211 creates a state option to verify the citizenship status of citizen kids with the Social Security Administration using their SSN and date of birth. This provision was included in both of the 2007 SCHIP bills, and again in the legislation that just passed. It was included because a 2005 law imposed paperwork barriers on citizen children seeking coverage to document their citizenship status that caused tens of thousands of eligible uninsured children to miss out on coverage. In 2007, Senator Hatch, a leading Republican on child health issues in the Senate had this to say about the claims that the provision allowed illegal immigrants to get SCHIP.
    “Many have suggested, in error, that our bill allows illegal immigrants to be covered under CHIP. In fact, during the House debate, I heard some state incorrectly that our bill provides benefits to illegal immigrants and opens the door for CHIP and Medicaid benefits for illegal immigrants by substantially weakening a requirement that persons applying for such services show proof of citizenship. Nothing could be further from the truth. In fact, our legislation has specific language stating that no illegal immigrants will be covered under CHIP.”
    I don’t want to suggest that Senator Hatch would say that now, even though Section 211 is the same as it was in the 2007 bill that he defended. From the floor debate this week, I gather that he, Senator Grassley, and other Republicans who worked on the earlier legislation are upset about how they feel they were treated in negotiations over the 2009 bill. This is really too bad. He, along with Senator Grassley (Iowa – R), did excellent work on many of the provisions in this bill, and it is distressing that they felt they had to vote against it.
    But, in my opinion, none of this changes that this is a good bill that kids need now more than ever.
    You can find the CBO score with the 4.1 million uninsured figure, the full text of the 2009 bill (and the earlier bills on which it was based) at http://ccf.georgetown.edu/index/schipreauthorization.

  8. for an accurate view of the opposition;
    This is their atual words
    “The Senate Republican Policy Committee said it objects to a provision of the bill that would allow states to waive the federally mandated five-year waiting period for documented immigrant children and pregnant women to qualify for SCHIP. The committee also said that a provision of the measure that would loosen citizenship documentation requirements could make it easier for undocumented immigrants to sign up for the program (CongressDaily, 1/27). In addition, Sen. Jon Kyl (R-Ariz.) expressed concern that the reauthorization bill does not go far enough to ensure that the program remains targeted at low-income families whose children have no access to health insurance (Freking, AP/Contra Costa Times , 1/26). According to Republican lawmakers, the expansion would cause 2.4 million children to leave private health plans to enroll in SCHIP (Washington Times , 1/27).Senate Finance Committee ranking member Chuck Grassley (R-Iowa) said that the provisions Republicans oppose are among those that were added since a bipartisan compromise was struck on SCHIP legislation in 2007.”
    “The sponsors of the SCHIP bill on the floor today will attempt to argue that the changes to the bill have addressed the problem of allowing illegal aliens to qualify for Medicaid. What the bill (specifically section 211) actually does is to eliminate the requirement that individuals must provide specified documents to establish that they are citizens and therefore eligible to participate in this government funded healthcare program. In its place, the bill requires that states must check names and Social Security numbers of applicants against the SSA database.”
    “Unfortunately this provision does not prevent illegal aliens from qualifying for Medicaid. Recent reports have highlighted the growing problem of the theft of valid Social Security numbers in conjunction with identity theft. In their April 2007 report, the President’s Identity Theft Task Force identified the SSN as the “most valuable commodity for an identity thief.” Section 211 will not prevent illegal aliens from using fraudulently obtained Social Security numbers to qualify for Medicaid.”
    “In communications with the staff at the Social Security Administration this morning, they confirmed this analysis of Section 211. Below are their responses to two questions that highlight why this provision will weaken current law and make it easier for illegal aliens to qualify for Medicaid.”
    Not really how you described it Jocelyn

  9. Jocelyn,
    Where did you get your 4.1 million number? Every study I have read said 4.1 million new enrollees are expected, that is not 4.1 million kids that where uninsured, 2 million of those are expected to come from exisiting policies being cancelled.
    With the increased income up to 80K plus covering your kid through SCHIP will be cheaper, for now, then covering them through your employer.
    Your missing the entire argument on the expansion of SCHIP to legal immigrants. Under the current law they must have a SSN, that is being eliminated and states are being allowed to enroll those without. In a perfect world where states did their job and verified the eligibility this wouldn’t be a problem. In the real world this opens a GIANT loophole to cover legal and illegal immigrants. Already states have zero documentation for 4.3% of enrolless and another 4% did not meet the qualifications yet where still enolled. There is another couple percent fraudlently enrolled in SCHIP instead og Medicaid for higher federal funding. Have younever read the PERM on SCHIP and the major double digit fraud/abuse/waste rate they have?
    The last thing we need to do is loosen the verification requirements on SCHIP but that is exactly what the Democrats did, eirly similar to what they did on mortgages.
    THe way you framed the opposition is vry misleading and ignores most of the facts.

  10. I’m probably not the best one to explain. From a child health perspective, it is clearly the right thing to make sure children don’t have to wait five years for coverage. For a child, especially one with speech delays, asthma, etc., this is a lifetime. But, I gather from listening to the Senate debate that, yes, some opponents of the provision do believe that it will encourage more legal immigrants to come to this country. I’m not an immigration expert, but I’m dubious as to the validity of this argument. My understanding is that families who come to the United States legally tend to move here for jobs, to be with family members, to escape persecution, and so can’t imagine that knowledge of potential SCHIP eligibility will become a decisive — or even relevant — factor in their decision-making.

  11. Constitutionally, legal immigrant children are US citizens as much as those that are born here. Right? Are we afraid of encouraging legal immigration? I’m not sure I understand this one…

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