Why Does President Bush Oppose the Expansion of SCHIP?

Abstract

Health reform has again emerged as a salient political issue (Gorin, 2007). In a March 2007 New York Times/CBS News poll, 64 percent of respondents supported a government guarantee of for everyone, and 47 percent said they would support a system administered by the government and financed by taxpayers (compared with 38 percent who supported the system) (Toner & Elder, 2007). In a June 2007 poll by the Kaiser Family Foundation (KFF, 2007), ranked second (behind Iraq) among issues the public wanted the presidential candidates to address; the most important issues were coverage and costs. More than half of the respondents, including a third of Republicans, would support A new plan that would make a major effort to provide insurance for all or nearly all of the uninsured BUT would involve a substantial increase in spending. In this light, it is not surprising that candidates from both parties have discussed reform (Toner, 2007). The expiration of the 10-year-old State Children's Health Insurance Program (SCHIP) on September 30, 2007, has given legislators an opportunity to address one segment of the uninsured problem. SCHIP grew out of the last major legislative battle for reform in the early 1990s. After the demise of the Clinton administration's 1993 Health Security Act, Congress passed the Balanced Budget Act of 1997 (P.L. 105-33), which significantly changed Medicaid by allowing coverage to in working families. The federal government provided matching funds to the states to cover in families with incomes up to 200 percent of the federal poverty level (FPL). However, states that had already raised their Medicaid eligibility levels above 150 percent could increase the eligibility level for uninsured an additional 50 percent above current levels and impose premiums, deductibles, or other cost-sharing measures (using a sliding scale up to 5 percent of the family's income). At a minimum, states initially received $2 million per year and were required to provide matching funds to receive their allocation. States also had the option of providing this coverage by either expanding Medicaid or establishing (or expanding) a state children's insurance program, or some combination of the two approaches. The primary targets of SCHIP were whose parents were temporarily unemployed, in transition between jobs, or employed in jobs that did not provide coverage, that is, families ineligible for Medicaid, but unable to afford private insurance. By 2006, 15 states had SCHIP eligibility levels above 200 percent of the FPL (Congressional Budget Office, 2007). Although SCHIP is a relatively small program, it, along with Medicaid, has made a difference (Dubay, Guyer, Mann, & Odeh, 2007; Kenney & Yee, 2007). Studies (Kaiser Commission on Medicaid and the Uninsured, 2007; Kenney & Yee) show that SCHIP has improved children's access to care, narrowed ethnic and racial disparities in access to care, increased preventive care, helped to improve the quality of care, made it more likely for to have a regular source of care, and resulted in improved outcomes and school performance. The most dramatic impacts of both Medicaid and SCHIP are found in early childhood. Access to reduces infant mortality, childhood deaths, and the rate of babies born with low birthweight. In a recent survey of health care leaders, a wide majority agreed that SCHIP has been successful in expanding access and increasing the rate of insurance among low-income children (Shea et al., 2007). Currently, SCHIP covers 6.6 million (Kaiser Commission on Medicaid and the Uninsured, 2006), and if expanded it could include more. Between 2007 and 2012, an additional $13 billion to $15 billion is needed to maintain SCHIP enrollments at their current levels (KFF, 2007). …