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CHIPRA Just the Facts, PLEASE. National Academy for State Health Policy October 2007. Cindy Mann Executive Director Georgetown University Health Policy Institute Center for Children and Families www.ccfgeorgetown.edu. Achievements.
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CHIPRAJust the Facts, PLEASE National Academy for State Health Policy October 2007 Cindy Mann Executive Director Georgetown University Health Policy Institute Center for Children and Families www.ccfgeorgetown.edu
Achievements • Sharp decline in uninsured rate among low -income children • Coverage has let children secure the care they need • Cost effective
Second Consecutive Year of Rising Number of Uninsured Children Uninsured rate of 11.2% Uninsured rate of 12.1% Source: Kaiser Commission for Medicaid and the Uninsured
IL States are Moving Forward NH VT ME WA MT ND MN MA OR NY ID SD WI MI RI CT WY PA NJ IA OH NE IN NV DE IL WV VA UT MD CO CA MO KS KY NC DC TN SC OK AR NM AZ GA AL MS TX LA AK FL HI Implemented or Recently Adopted Legislation to Improve Children’s Coverage (26 states and DC) Considering Significant Proposal to Improve Children’s Coverage (3 states) Source: As of September 25, 2007 based on CCF review of state initiatives.
But A Showdown Nonetheless Congress The White House
Key Elements • Eligibility for children • Incentives/options to cover children already eligible but unenrolled • Adult coverage • Benefits • Public/private
CHIPRA Is Projected to CoverNearly 4 Million Otherwise Uninsured Children 3.8 Million Otherwise Uninsured Children Children Newly Eligible Through SCHIP Expansions Uninsured Children Already Eligible 84% Eligible Under Current Program Rules Children Currently in SCHIP Who Could Lose Coverage Note: Average monthly enrollment for fiscal year 2012; SCHIP & Medicaid would cover 5.8 million children when reductions in other coverage are included; numbers may not sum due to rounding. Source: CBO estimate of changes in SCHIP and Medicaid enrollment of children under the House Amendments to the Senate Amendments to H.R. 976, the Children’s Health Insurance Program Reauthorization Act of 2007 (September 24, 2007).
CHIPRA Targets Children Currently Eligible but Unenrolled 9 Million Uninsured Children 4.4 Million are Eligible for Medicaid 1.7 Million are Eligible for SCHIP Source: L.Dubay analysis of March 2005 Current Population Survey using July 2004 state eligibility rules
Coverage Gains Over the Past Decade Have Come Equally from Medicaid & SCHIP Enrollment of Children in Public Coverage (Millions) 34.0 32.3 30.8 27.2 25.2 23.5 22.3 21.0 Source: CCF, Preliminary data. Based on children ever-enrolled over the course of a year.
White House Veto • WH proposed $4.8b in new federal funds • Favors “free competitive marketplace”/private coverage • Crowd out concern/income eligibility • Objection to offsets
Focus on Low-Income Uninsured Children Limits “Crowd Out” CHIPRA “I think (the Senate Finance Committee) approach is pretty much as efficient as you can possibly get per new dollar spent to get a reduction of roughly 4 million uninsured children.”Peter Orszag, CBO Director (July 19, 2007) 5.8 Million Children Children Who Otherwise Would Have Had Coverage Otherwise Uninsured Children Source: CBO Estimate of Changes in SCHIP and Medicaid in Enrollment of Children under CHIPRA 2007 (September 25,2007.
States Have Reasons for Moving ForwardGrowth in Family Insurance Premiums Compared to the Federal Poverty Level Note: This data represents the cumulative growth in employee premium contributions for employer-sponsored family health insurance and the cumulative growth in the federal poverty level for a family of three. Source: Agency for Healthcare Research and Quality estimates of 1996-2005 Medical Expenditure Panel Survey Insurance Component Tables, generated using MEPSnet/IC (August 21, 2007); and CCF analysis of 1996-2005 Federal Poverty Guidelines.
Distribution of the Increase in Uninsured Children, by Income, 2005-2006 150,000 400%+ FPL 340,000 200-399% FPL 220,000 <200% FPL Source: Urban Institute for the Kaiser Commission on Medicaid and the Uninsured
Most Children Covered by SCHIP Have Family Incomes Below 200% FPL 6.7 million children enrolled in SCHIP, 2006 At or Below 200% FPL Above 200% FPL Note: The reporting classification of a child with family income above 200% FPL who Is determined to be eligible at or below 200% FPL due to deductions or disregards (I.e., a net income test) is up to the discretion of the state and constrained by their reporting systems. Source: CCF analysis using enrollment data from C. Peterson & E. Herz, Estimates of SCHIP Child Enrollees Up to 200% of Poverty, Above 200% of Poverty, and of SCHIP Adult Enrollees, Congressional Research Service (March 13, 2007).
