SCHIP

SCHIP - What is SCHIP?

The State Children's Health Insurance Program (SCHIP) – later known more simply as the Children's Health Insurance Program (CHIP) – is a program administered by the United States Department of Health and Human Services that provides matching funds to states for health insurance to families with children.

The program was designed with the intent to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid.

At its creation in 1997, SCHIP was the largest expansion of taxpayer-funded health insurance coverage for children in the U.S. since Medicaid began in the 1960s. The statutory authority for SCHIP is under title XXI of the Social Security Act.

It was sponsored by Senator Ted Kennedy in a partnership with Senator Orrin Hatch with support coming from First Lady Hillary Rodham Clinton during the Clinton administration. In FY 2008, the program faced funding shortfalls in several states.

During the administration of George W. Bush, two attempts to expand funding for the program failed when Bush vetoed them. Mr. Bush argued that such efforts were steps toward federalization of health care, and would "steer the program away from its core purpose of providing insurance for poor children and toward covering children from middle-class families."

On February 4, 2009, President Barack Obama signed the ''Children's Health Insurance Reauthorization Act of 2009'', expanding the healthcare program to an additional 4 million children and pregnant women, including for the first time legal immigrants without a waiting period.

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SCHIP History

As a part of the fallout from the failed 1993 Clinton health care plan, both Democratic Senator Ted Kennedy and the Clinton administration were looking for smaller initiatives for publicly-funded health care that could gain bipartisan support.

Kennedy was intrigued by a children's health insurance plan in Massachusetts that had passed in 1996, and met with a Boston Medical Center pediatrics director and a Massachusetts state legislator to discuss the feasibility of a national initiative. Kennedy also saw using an increase in tobacco taxes as a way to pay for the expanded coverage.

Meanwhile, in December 1996 First Lady Hillary Rodham Clinton examined several possible such initiatives and decided expanding health care insurance to children who had none was the one to advance. Additionally, Hillary Clinton had discussed an SCHIP-ish program with a White House health policy coordinator during the time her full-blown health care plan had suffered political failure.

The new initiative was proposed at Bill Clinton's January 1997 State of the Union address, with the stated goal of coverage up to five million children. and conservative commentators. The First Lady did not hold news conferences or testify before Congress on behalf of the bill. Kennedy and Hatch scoffed at the objection, with the former saying, "If we can keep people healthy and stop them from dying, I think most Americans would say 'Amen; isn't that a great result?' If fewer people smoke, states will save far more in lower health costs than they will lose in revenues from the cigarette tax."

Then the bill had to comply with the existing balanced budget agreement between Congress and the White House, something that Lott said it did not. Hillary Clinton defended her husband's action at the time, saying "He had to safeguard the overall budget proposal," At a press conference following the signing, Kennedy thanked Hatch, Senate Minority Leader Tom Daschle, Children's Defense Fund head Marian Wright Edelman, Bill Clinton, and Hillary Clinton. On 25 June 1997, H.R. 2015 passed House Vote Roll #241 mainly among partisan lines, 270 ayes and 162 nays, with most Democrats in the House of Representatives in opposition.

On the same day, the bill passed in the Senate, with a substitute amendment, by unanimous consent. After a conference between the House and Senate, passage in both House (Roll #345: 346-85) and Senate (Roll #209: 85-15) on the conference substitute became more bipartisan.

This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "State Children's Health Insurance Program" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.

SCHIP Reauthorization

SCHIP was created in 1997 as a ten-year program; to continue past federal fiscal year 2007, passage of a reauthorization bill was required.

The first two reauthorization bills to pass through Congress would also expand the program's scope; President George W. Bush vetoed them as improper expansions.

A two-year reauthorization bill was signed into law by the President in December 2007 that would merely extend current SCHIP services without expanding any portion of the program.

With the 2008 Presidential and Congressional elections bringing Democrats to a majority in both houses of Congress and to the Oval Office, SCHIP was reauthorized and expanded in the same bill through fiscal year 2013.

2007 reauthorization

HR 976

In 2007, both houses of Congress passed a bipartisan measure to expand the SCHIP program. The measure would have expanded coverage to over 4 million more participants by 2012, while phasing out most state expansions in the program that include any adults other than pregnant women.

The bill called for a budget increase for five years totaling $35 billion, increasing total SCHIP spending to $60 billion for the five-year period. Opposition to HR 976 focused on the $35 billion increase in government health insurance as well as $6.5 billion in Medicaid benefits to illegal immigrants.

Originally intended to provide health care coverage to low-income children, HR 976 was criticized as a giveaway that would have benefited adults as well as non-U.S. citizens. The program expansion was to have been funded by sharply increasing federal excise taxes on tobacco products.

On the other hand, opponents said this proposed expansion was for families with annual incomes up to $82,600 (400 percent of the federal poverty level)

On October 3, 2007, President Bush vetoed the bill, stating that he believed it would "federalize health care", expanding the scope of SCHIP much farther than its original intent. The veto was the fourth of his administration.

On October 18, 2007, the House of Representatives fell 13 votes short (273-156) of the two-thirds majority required to override the president's veto, although 44 Republicans joined 229 Democrats in supporting the measure.

HR 3963

Within a week of the failed veto override vote, the House passed a second bill attempting a similar expansion of SCHIP.

According to Democrats the second bill, created firmer caps on income eligibility, prevented adults from joining, and banned children of illegal immigrants from receiving benefits.

According to its opponents, however, this second proposed expansion was for families with annual incomes up to $62,000 (300 percent of the federal poverty level). and a House vote in January 2008 failed to override the veto.

Public Law 110-173

Congress ultimately passed , which extended SCHIP funding through March 31, 2009, and the President signed it into law on December 21, 2007.

2008 reauthorization

In the wake of President Barack Obama's inauguration and the Democrats' increased majorities in both houses of Congress, legislative leaders moved quickly to break the political stalemate over SCHIP expansion.

On January 14, 2009, the House passed on a vote of 290-138.

The bill authorized spending an added $32.8 billion to expand the health coverage program to include about 4 million more children, including coverage of legal immigrants will fund the program's expansion. On January 29, the Senate passed the house bill by a 66-32 margin, with two amendments.

The House accepted the amended version on a vote of 290 to 135, and President Obama signed the bill into law as on February 4, 2009.

Arizona rescission

In early 2010, Arizona Governor Jan Brewer, along with the House and Senate of the state passed a budget that eliminated S-CHIP, known as KidsCare in Arizona.

As of 22 April 2010, the state assembly, after learning they will lose federal matching and stimulus funds, is looking at restoring some of the program, but not allowing new enrollment.

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SCHIP Administration

Like Medicaid, SCHIP is a partnership between federal and state governments. The programs are run by the individual states according to requirements set by the federal Centers for Medicare and Medicaid Services. States may design their SCHIP programs as an independent program separate from Medicaid (separate child health programs), use SCHIP funds to expand their Medicaid program (SCHIP Medicaid expansion programs), or combine these approaches (SCHIP combination programs).

States receive enhanced federal funds for their SCHIP programs at a rate above the regular Medicaid match.

By February 1999, 47 states had set up SCHIP programs, but it took effort to get children enrolled. the campaign would fall under the aegis of the Health Resources and Services Administration.

By April 1999, some 1 million children had been enrolled, and the Clinton administration set a goal of raising the figure to 2.5 million by 2000.

States with separate child health programs follow the regulations described in Section 42 of the Code of Federal Regulations, Section 457.

Separate child health programs have much more flexibility than Medicaid programs. Separate programs can impose cost sharing, tailor their benefit packages, and employ a great deal of flexibility in eligibility and enrollment matters.

The limits to this flexibility are described in the regulations, and states must describe their program characteristics in their SCHIP state plans.

Out of 50 state governors, 43 support SCHIP renewal. Some states have incorporated the use of private companies to administer portions of their SCHIP benefits.

These programs, typically referred to as Medicaid managed care, allow private insurance companies or health maintenance organizations to contract directly with a state Medicaid department at a fixed price per enrollee.

The health plans then enroll eligible individuals into their programs and become responsible for assuring SCHIP benefits are delivered to eligible beneficiaries.

In Ohio, SCHIP funds are used to expand eligibility for the state's Medicaid program. Thus all Medicaid rules and regulations (including cost sharing and benefits) apply.

Children from birth through age 18 who live in families with incomes above the Medicaid thresholds in 1996 and up to 200% of the federal poverty level are eligible for the SCHIP Medicaid expansion program.

In 2008, the maximum annual income needed for a family of four to fall within 100% of the federal poverty guidelines was $21,200, while 200% of the poverty guidelines was $42,400.

Other states have similar SCHIP guidelines, with some states being more generous or restrictive in the number of children they allow into the program. SCHIP Medicaid expansion programs typically use the same names for the expansion and Medicaid programs. Separate child health programs typically have different names for their programs. A few states also call the SCHIP program by the term "Children's Health Insurance Program" (CHIP).

States are allowed to use Medicaid and SCHIP funds for premium assistance programs that help eligible individuals purchase private health insurance. As of 2008 relatively few states had premium assistance programs, and enrollment was relatively low. Interest in this approach remained high, however.

In August 2007, the Bush Administration announced a rule requiring states (as of August 2008) to sign up 95% of families with children, earning 200% of the federal poverty level, before using the funds to serve families earning more than 250% of the federal poverty level. The federal government said that 9 out the 17 states that offer benefits to higher-earning families were already compliant. Opponents of this rule argued that signing up higher-income families makes lower-income families more likely to sign up, and that the rule was incompassionate toward children who would otherwise go without medical insurance.

California's Healthy Families

Healthy Families is low cost insurance for children and teens. It provides health, dental and vision coverage to children who do not have insurance and do not qualify for free Medi-Cal. California's Office of the Patient Advocate provides quality ratings on Healthy Family plans in California.

This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "State Children's Health Insurance Program" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.

SCHIP Debate

SCHIP has cost the federal government $40 billion over its first 10 years, and the debate over its fiscal impacts reflects the larger debate in the U.S. over the government's role in health care.

In 2007, researchers from Brigham Young University and Arizona State found that children who drop out of SCHIP cost states more money because they shift away from routine care to more frequent emergency care situations.

The conclusion of the study is that an attempt to cut the costs of a state healthcare program could create a false savings because other government organizations pick up the tab for the children who lose insurance coverage and later need care.

Detractors of the program focus on the impact to the private health insurance industry. In a 2007 analysis by the Congressional Budget Office, researchers determined that "for every 100 children who gain coverage as a result of SCHIP, there is a corresponding reduction in private coverage of between 25 and 50 children."

The CBO speculates this is because the state programs offer better benefits at lower cost to enrollees than the private alternatives.

A briefing paper by libertarian think-tank Cato Institute estimated the "crowding out" of private insurers by the public program could be as much as 60%.

This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "State Children's Health Insurance Program" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.