States Moving Forward — Will the Federal Government

States Moving Forward - Will the Federal Government Remain a Partner? Capitol Beat Conference Philadelphia, Pennsylvania August 4, 2007 Cindy Mann Executive Director Georgetown University Health Policy Institute Center for Children and Families

Achievements

Trends in the Uninsured Rate of Low-Income Children, 1997 - 2005 Source: CCF analysis of National Health Interview Survey.

Challenges

SCHIP Spending is Rapidly Outpacing New Funds Being Made Available (in billions) Source: 1998 -2007 data from Chris Peterson. SCHIP Original Allotments: Funding Formula Issues and Options. Congressional Research Service (October 2006); 2008 -2012 data from Center on Budget and Policy Priorities’ SCHIP financing model (Nov. 2006).

Of the 9 Million Uninsured Children, 6. 1 Million Are Already Eligible for Medicaid/SCHIP 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

Where Do We Go From Here?

States are Moving Forward NH VT WA MT ME ND MN OR MA NY ID SD WI MI WY IA IL IL CA CO MO KS IN OK AZ VA KY NC TX MD DC SC AR MS AK NJ DE WV TN NM RI OH NE NV UT CT PA AL GA LA FL HI Implemented or Recently Adopted Legislation to Improve Children’s Coverage (26 states and DC) Considering Significant Proposal to Improve Children’s Coverage (2 states) Source: As of August 2, 2007 based on CCF review of state initiatives.

States are Moving Forward • 9 states have expanded eligibility – (AK, DC, MT, NC, OH, OK, PA, SC, WV) • 8 states have simplified the enrollment process – (AZ, CT, IA, MN, NH, TX, UT, VT) • 10 states have both expanded eligibility and simplified enrollment – (CO, HI, IL, IN, LA, MA, NY, ND, TN, WA) Note: Enacted legislation between January 2006 and July 2007. Source: Center for Children and Families analysis of state initiatives.

SCHIP Reauthorization: Senate and House Bills (5 year spending) House Offsets Senate Offsets • 61 -cent increase in tobacco tax • Reduction in overpayments to Medicare Advantage plans • 45 -cent increase in tobacco tax • Other sources Source: Based on CBO numbers for H. R. 976 ( July 26, 2007) and H. R. 3162 ( August 1, 2007)

Both Bills Would Primarily Target Uninsured Children Already Eligible 5 Million Uninsured Children 4 Million Uninsured Children 92% Already Eligible Note: Average monthly enrollment for fiscal year 2012 Source: Based on CBO estimate of H. R. 976 (July 26, 2007) and H. R. 3162 (August 1, 2007). 88% Already Eligible

Focus on Low-Income Uninsured Children Limits “Crowd Out” “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)

The Cost of Coverage Person: Medicaid vs. Private Insurance Note: Differences between Medicaid and private insurance per capita expenditures (in 2001 dollars) are significant at the 5% level. Source: Hadley & Holahan, “Is Health Care Spending Higher Under Medicaid or Private Insurance? ” Inquiry. Winter 2003/2004.

White House Veto Threat • “Democrat leaders in Congress are considering a massive expansion of government health care through a program called S-CHIP… • …S-CHIP would expand its reach to include children from family(sic) that earn as much as $80, 000 a year, as well as some adults. • At the same time that they try to expand S-CHIP to older citizens, they are trying to expand Medicare to younger citizens. Their goal is to take incremental steps down the path to government-run healthcare for every American. It’s the wrong path for our nation. ” - President George W. Bush (June 27, 2007)

Implications of a Veto: Even Before Recent State Activities Most States Would Face Shortfall Without a Strong Reauthorization Number of States Facing Federal SCHIP Shortfalls (February 2007 Projections) Source: Center on Budget and Policy Priorities' analysis using an SCHIP financing model.

A Diverse Set of Groups Support a Strong SCHIP Reauthorization Government Faith-Based Organizations Providers/ Business Groups Unions

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

States Moving Forward - Will the Federal Government Remain a Partner? NH VT WA MT ME ND MN OR MA NY ID SD WI MI WY IA IL IL CA CO MO KS IN OK AZ VA KY NC TX MD DC SC AR MS AK NJ DE WV TN NM RI OH NE NV UT CT PA AL GA LA FL HI Implemented or Recently Adopted Legislation to Improve Children’s Coverage (26 states and DC) Considering Significant Proposal to Improve Children’s Coverage (2 states) Source: As of August 2, 2007 based on CCF review of state initiatives.