SCHIP Reauthorisation: Key Questions in the Debate – A Description of New Administrative Guidance and the House and Senate Proposals

The Kaiser Family Foundation’s Kaiser Commission on Medicaid and the Uninsured has a special section running, concerning the State Children’s Health Insurance Program (SCHIP). It also has this policy brief, which runs through the SCHIP, briefly, and implications for certain aspects under review – such expanding it, reducing it or keeping funding static:

KFF Figure 2

KFF Figure 5

Among the issues covered in only 10 pages are the extent of crowing out (the argument that SCHIP is used by families who would otherwise buy private health insurance – an argument that, to this health economist, is retarded before it is even articulated but, then, I’m not from around here), and the effects of insurance health care access and utilisation (very important when considering the health, human capital and future earnings of children):

KFF Figure 7

Both the Senate and House passed legislation to reauthorize SCHIP. Congress will need to reach agreement on the policy options as well as the funding levels and funding offsets to be able to send a single bill to the President to sign into law by September 30, 2007; however the President has threatened to veto either the House or the Senate versions. The Administration also just released new guidance to states on August 17th that would limit states’ ability to expand SCHIP coverage to children in families with incomes above 250 percent of the poverty line which stands in conflict with Congressional efforts to expand the program to address the increasing number of uninsured children in middle income families.

New Census data shows a continued increase in the numbers and rate of uninsured children driven by continued declines in employer sponsored coverage. In the face of declining employer sponsored coverage, SCHIP will not be able to support current program levels or expand to cover more uninsured children without additional federal funding. If SCHIP is not reauthorized by the end of the fiscal year, the program will expire leaving states without federal funds to support coverage for the over million children currently covered by the program and putting these children at risk of being uninsured.

Something that stands well out is the line about the Executive branch of the United States government telling the State level of the Legislative Branch what it can do with a State responsibility. Even in the current climate of centralisation of power/authority, that strikes one as fairly brazen.

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