Getting to the Finish Line on Children’s Coverage

1. Getting to the Finish Line on Children’s Coverage

2. Getting to the Finish Line on Children’s Coverage Cindy Mann Center for Children and Families Georgetown University Health Policy Institute http://ccf.georgetown.edu National Health Policy Forum Universal Coverage for Children: States Setting the Pace September 19, 2008

3. Setting the Context • State economic conditions • State actions • Federal actions

4. State Budget Woes Worsening FY 2009 WA NH VT MT ME ND OR MN MA ID WI SD NY WY MI RI CT IA PA NV NE NJ OH IL UT IN DE CO CA WV KS VA MD MO KY NC DC TN AZ OK NM AR SC MS AL GA TX LA AK FL HI States with Budget Shortfalls in FY09 (30, including DC) States with Additional Mid-Year Shortfalls (13 states) Source: E. McNichol and I. Lav, “State Budget Troubles Worsen,” Center on Budget and Policy Priorities (September 8, 2008).

5. Moving Forward Even in Challenging Fiscal Climate “We are making tough decisions, but we're doing that while also protecting the core priorities, such as education, providing health care to our children and supporting tax reform that I believe will help revitalize our economy in the long run.” Governor Ted Strickland (D-OH) announcing $540 million in cuts (September 10, 2008)

6. States Moving Forward 2008 WA NH VT MT ME ND OR MN MA ID WI SD NY WY MI RI CT IA PA NV NE NJ OH IL UT IN DE CO CA WV KS VA MD MO KY NC DC TN AZ OK NM AR SC MS AL GA TX LA AK FL HI Enacted New Legislation/Took Administrative Action to Improve Child and Family Coverage (10 states) Implemented 2007 Legislation to Improve Child and Family Coverage (15 states) Source: As of September 4, 2008 based on a review by the Center for Children and Families of state initiatives in 2007 and 2008.

7. States Moving Forward • In 2008, 19 states authorized new measures or implemented measures approved in 2007 • Continues a 4-year trend: since 2005, two-thirds of states have made significant improvements in their children’s coverage programs • Changes include improvements to boost enrollment among already-eligible children and eligibility expansions

8. Reaching the Eligible but Unenrolled Children Procedural closings in Louisiana: < 1% Source: LaCHIP/Medicaid Eligibility Division, La. Department of Health & Hospitals, September 2008

9. Assuring Eligible Children Can be Enrolled “We have made great strides in improving access to health care for our vulnerable children.” Governor Huntsman (R-UT) celebrating the 10th Anniversary of SCHIP (August 21, 2008)

10. Eligibility Changes • Over the past 4 years, 22 states have enacted eligibility expansions in SCHIP/Medicaid • Currently, 45 states have enacted legislation to cover children ≥200% of FPL and 20 states have authorized coverage ≥300% of FPL

11. Premiums for Employer-Sponsored Coverage Are Growing Faster than Workers Earnings Source: Center for Children and Families analysis of Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2007; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999-2007 (April to April).

12. The “Welcome Mat” Effect Source: Center for Children and Families,”Putting Out the Welcome Mat: Implications of Coverage Expansions for Already-Eligible Children” (September 9, 2008).

13. States are Leading the Way but Federal Action is Essential • SCHIP reauthorization • August 17th Directive • FMAP • Health reform

14. Missed Opportunity: CHIPRAWas Projected to Help States Cover Nearly 4 Million Additional 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).

15. What Happens on March 31, 2009? Number of States that Will Face Funding Shortfalls in FY 09 Source: C. Peterson, “What Happens to SCHIP After March 31, 2009?,” Congressional Research Service (July 22, 2008).

16. Emily is Waiting

17. The program needs stable funding Policy issues addressed in CHIPRA need to be resolved Uncertainty can stop or even unravel progress But SCHIP reauthorization is not health reform; children as well as adults have much at stake in the broader health reform debate The Imperative for SCHIP Reauthorization

18. Americans Support Covering Children 91% July 23, 2007 Source:Poll conducted by Lake Research Partners and American Viewpoint, national survey of 1,002 American voters from June 26 - July 1, 2007 for the Center for Children and Families

19. Why? “Finally, we must do this -- and do it now -- because supporting children's health is vital to supporting Kentucky's future. So much depends on laying a proper foundation for our children's lives at the earliest possible age. With this KCHIP plan we take a significant step forward toward that goal.” Governor Steve Beshear (D-KY) “Reversing Course on Children’s Health,” Louisville Courier-Journal (September 14, 2008)