SCHIP is a federally funded, but state administered health insurance program for children that was created in 1997. Up to now, it has provided benefits for children in families with incomes up to 200 percent of the federal poverty level. According to the Congressional Budget Office, SCHIP has reduced the number of children living without health insurance. Between 1996 and 2005, the percentage of families with incomes between 100 and 200 percent of the federal poverty level who were uninsured fell from 22.6 to 16.9 percent.
The SCHIP expansion, as passed by Congress, would increase funding by $35 billion over five years. (President Bush’s FY08 budget proposed a $4.8 billion increase over five years.) It would also allow states to make families with incomes up to 300 percent of the federal poverty level eligible for benefits under the program. This increase would be funded by an increase in federal cigarette taxes – the increase in revenue being required under Congressional PAYGO rules, which require any increase in spending to be matched by an increase in revenue.
In a paper released about a month ago, The Concord Coalition pointed out a number of problems with the proposed SCHIP expansion. According to the Coalition, the SCHIP expansion complies with PAYGO rules, but only in a technical sense. In order to comply with PAYGO, appropriations for the expansion are to be dramatically reduced in FY 2012. However, a special appropriation to be made that year – one that will not be counted toward PAYGO compliance – will make up for the reduction in regular financing. In other words, when all costs are included, the SCHIP expansion will cost more than the new revenues being allocated.
Another longer-term fiscal issue with the SCHIP expansion is the revenue source being used to offset it. Cigarette taxes are a diminishing revenue source over the long term. Over a period longer than the five years provided for in the proposed expansion, cigarette tax rates would need to be periodically increased in order to match the increase in spending just to maintain services at stable levels. At a certain point, the ability of cigarette taxes to support SCHIP would diminish significantly. While using cigarette taxes to fund childrens’ health programs sounds great, it doesn’t work over the long-term.
The Concord Coalition also points out that the SCHIP expansion is not accompanied by any means of cost control. Given the size of increases in health care costs that affect all sectors of the economy, it is not reasonable to support an expanded program simply with a tax increase, as the congressional SCHIP expansion does.
Finally, the expansion of the program targets families that may have less need for the benefits. The need for such a program for families making less than 200 percent of federal poverty level is well-established – and in this sense, the program has been a success. The degree to which families making between 200 and 300 percent of federal poverty level do not have available health care coverage is not clear. According to the Concord Coalition, “some evidence exists that some parents who otherwise would have enrolled their children in private plans are switching coverage to SCHIP.”
Even if children whose families make between 200 and 300 percent of federal poverty level ought to receive benefits under SCHIP, the expanded program must be funded in a responsible and stable manner over the long term. Budget deficits and long-term obligations in Social Security and Medicare already challenge the long-term economic health of this country. The children being served now by SCHIP will potentially face in their middle age economic stagnation brought about by choices being made now.
Congress is certainly not the only party to blame for this. While President Bush is narrowly correct on the fiscal questions surrounding the SCHIP expansion, his tax cuts and his open-ended commitment to military operations in Iraq dwarf any fiscal effect produced by SCHIP. Without the tax cuts and our Iraq operations, it might be possible to consider a fiscally sound method of funding SCHIP at the levels proposed by Congressional Democrats.
I agree that most people lack an understanding surrounding this issue.
I think that many don’t realize that this program has been in place and completely funded since 1997. The issue now before us is should it be expanded/increased to include children ( if you consider someone that’s 25 as a child) and families with incomes of $82,000 for child health care?
The ADDITIONAL cost? … $35 billion
The revenue source? ..currently addicted cigarette smokers.
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This bill needs a lot of work.
New York State applied for that income limit from HHS, and was turned down. It varies state by state, but there are now limits in the law that are far below that.
The sources of the $82,600:
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New York sought a waiver for 400% poverty rate coverge (i.e. $82,600), and the Administration denied the request.
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http://www.midhudson…
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New York State then filed lawsuit challenging the Administration’s disapproval of its request to allow SCHIP to cover children in some families making as much as $83,000 per year.
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This is a standard talking point, used by President Bush and others, to make it seem like that’s the rule, like that’s what’s going to happen. That is totally false. And to cite this as the fact of what’s going to happen is not telling truth — until such time as NY actually wins its appeal.
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Personally, I’m sympathetic to NY’s case, but that’s neither here nor there.
Ok, until it win’s it’s court case, or not.
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In the meantime, NJ limits are $72K. No smoke, no mirrors. Families earning $72K qualify for welfare under the SCHIP expansion.
I think that one ( of numerous) problems that conservative people have with the bill in its current form is that extends benefits to people ( 25 year old children?)of families that clearly have the MEANS ( incomes of $80k)to provide health care to their children. The real losers in this are the children who really need health care that they can not afford while “children” of 300% + poverty level ( after adjustments) families divert and drain funds from them.
IMO, the issue here is NOT screwing children in need of health care as the program has been in place, funded and CONTINUES to be funded to cover those truly in need since 1997…rather the issue is expanding the program to cover those well above a reasonable means test.
The other question that lingers is the funding…..after the liberals have taxed the pathetic nicotine drug addicted smokers into quitting because they simply can’t afford to buy $6 /pack cigarettes and have no choice but to quit …where will the money come from to perpetuate the program? … How pissed off will they be when a Ben and Jerrys Ice cream tax is imposed on people weighing over 275 lbs ? and then what to tax next to maintain the revenue stream ? Think about it.
… not to do a bill expanding health care, particularly if you’re the Concord Coalition and mostly concerned about fiscal stuff. And while you wait for the perfect bill, more kids get sick and can’t afford adequate treatment, and very possibly many of them develop conditions that become very costly in the long term … for someone.
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You’ve put your finger on the problem in the last paragraph: The Bush tax cuts. They’re insane, unsustainable, and a recipe for disaster considering the coming baby boom retirement and stress on Medicare and Medicaid. Let them sunset. Your first and second objections are valid; but for now, however, I think it’s a reasonable thing for Congressional Dems to kick that can down the road a bit. Put it on the long, long list of fiscal repairs the next administration is going to have to deal with. It will not be easy, but it is necessary.
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And as I mentioned on your blog, David: Massachusetts already subsidizes health care for those under 300% of poverty level. I suggest you look at the health insurance “products” available in the market, and ask yourself whether you think they’re affordable — without subsidy — for people making between 200%-300% of FPL. You say it’s “questionable”; to me, they’re plainly unaffordable.
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The cost issue is real, it is ominous, it is grave. But it deserves its own agenda and set of measures. I keep hearing “there’s no constituency for cost-control” … but it’s going to come up one way or another.
For me, the public policy goal of SCHIP should be to make sure that children who would be otherwise uninsured or underinsured get coverage.
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Yes, unsubsidized health plans are expensive for middle income familes, but I’m not sure the extent to which kids are going uninsured because of it.
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My larger point, though, is that if we establish the need to subsidize insurance for these kids, we need to find a better way to pay for it than the cigarette tax – and Congress needs to be more straightforward about the costs – and their contribution to the federal deficit.
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I don’t think we should wait until the next administration to make sure that either new programs or expanded existing programs are structured in a fiscally responsible way.
that you do support waiting for the next Congress to insure those kids — if they ever got around to it. The cigarette tax was the way to make the bill happen at all. Perversely, if you made it “fiscally responsible” in a way that you, I, and the Concord Coalition would recognize (e.g. rescinding Bush’s tax cuts), the Republicans in Congress would want no part of it. That’s just political reality.
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So we have a choice: pass the law and fix the funding later; or no law. How do you like your sausage?
That there’s really a need to expand the program.
that you look at the programs available through the Connector, and imagine that someone of 200%-300% of FPL is made to buy them. If you do that, I think you’ll know what I’m talking about. If not, you at least need to be specific about the reasons for your skepticism.
And I stand by my earlier statement that coverage is certainly expensive for middle income families, but not necessarily unaffordable.
that those kids need insurance? Because that’s what this is about. We can go around and around on what’s affordable and what’s not (and I do wish you’d be very specific about that). But this law notes that there’s a problem of uninsurance in that population; and arranges for those kids to get insurance.
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“Personal responsibility” as a consideration only goes so far in this situation, because we’re talking about people who by definition are not responsible for themselves.
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It’s simple: Cover the kids, make it happen, no excuses. There are better and worse ways to do that, and I’m not going to defend everything about the law. But I support the law, warts and all.
How big is the problem of uninsurance among the 200 to 300 percent FPL families – and does it require a $35 billion fix?
You are so wrong about that.
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We were uninsured for 6 years, because both of us were “contractors” or selfemployed. We were struggling to make ends meet in a really tough rental market, barely holding our heads above water despite a quite decent living we were making, with no kids.
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Things eased a bit over time, but not $400+-a-month eased. Luckily, my husband finally got hired for real at his job after 6 years, but before then, it wasn’t a matter of priorities – it was a matter of eat and have a roof over our heads, or have health care.
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That’s a family with no kids, making a decent wage. I’d say we were at least 200%, maybe even a lot more, above poverty level.
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That’s how ridiculous health coverage costs have been. The Connector does alleviate some of that, but you’re getting shitty coverage for it, high deductibles, and less is covered. So all the things we needed coverage for – maintenance and regular checkups – would have come out of pocket anyway.
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As a result, both our health suffered for lack of care. I can’t tell you how mad I am at the system for allowing us to go through that, and even more so, to allow kids to go through it.
What stopped you from seeking necessary care, other than the lack of insurance?
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To this day I have family members who pay out of pocket — albeit slowly — for their health care needs. For some, this means $10/mo. But they pay it, and never have they been charged interest or had collection agencies call.
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I used to work part-time for a doctor’s office, and I know that he, too, was very flexible in the amount he charged and quite accommodating in A/R.
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Were these options not available to you?
When you’re worried if you can pay the minimums on debt from back when you were REALLY strapped and had to use plastic to eat, plus paying rent, plus trying to commute (expensive whether by car or by train), plus doing that strange eating thing still, the last thing you prioritize is health. $70 for a single dentist visit seems impossible. Not to mention, there’s the disincentive to see a GP because, god forbid they find some sort of disease, it’s a pre-existing condition for when you DO finally get on insurance.
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So, things actually accumulate and get worse. Like a tooth which gets so bad, it’s a root canal ($900) or just yanking it out ($100) and you choose to yank it. Yeah, it’s playing the odds, and it’s a crapshoot, and you’re praying like mad that you beat the clock, but what else can you do? Paying 100% of your own premiums is so expensive, the alternative (waiting until you need the ER) seems the only alternative.
I agree, however, that this is still not well known.
that the focus should be on the degree to which families are actually uninsured in that 200 to 300 percent of FPL. I would be more persuaded of the need for the SCHIP expansion if there were a large number of uninsured families in that income range.
Can you please do some Googling and tell us what you find out about that?
Robert Wood Johnson Foundation. Read up and digest for us.
The problem of uninsurance may not be so much a problem of eligibility as simply getting eligible families to sign up for existing programs. I quote page 2 of the study – “while millions of children have been helped through Medicaid and the State Children’s Health Insurance Program (SCHIP) are eligible to receive low-costor free health coverage, but are not enrolled.”
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I don’t see any indication so far that the problem is significnt among middle income families.
“while millions of children have been helped through Medicaid and the State Children’s Health Insurance Program (SCHIP), millions more are eligible to receive low-cost or free health coverage, but are not enrolled.”
but the money isn’t there to cover them.
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To your original question:
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So you’re talking about 1.2 million kids.
I may do that out of curiosity, but I think that the burden of marshalling evidence should be on the proponents of expansion.
We all agree that its a shame that millions of kids are without health insurance. The quesiton we keep coming back to is: What should the government pay for? For my part, we’ve spent $458 billion over 4 years on a completely unnecessary war in Iraq that George Bush refuses to end. But we can’t come up with $30 billion over 5 years to give some kids health insurance? Huh?
1.2 million kids uninsured in the 200 to 300 percent FPL range is certainly a need worth meeting. (See discussion below.) Whether $30 billion over five years (the difference between the President’s and Congress’ plan) is needed to meet this need is another question. It probably does not make a great deal of difference for the nation’s fiscal condition whether the real number is $20 billion or $30 billion.
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I still don’t need to like the conduct of the President, the Congress, and the media in all of this. (And I did mention all three in my original post.) I certainly understand about laws and sausages, but the level of b—s–t on both ends of Pennsylvania Avenue does not contribute to public confidence in our government – something that is very corrosive in the long-run.
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Charley, I appreciate the fact-filled discussion.
that it’s a total of 4 million kids that will newly get coverage, many of whom are already eligible. So that’s what the new money is going towards — not just the 200-300% FPL kids.
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Seriously, it’s a great question as to whether this is the most efficient way to spend that money. Is this a big fat giveaway to the insurance industry? How are we spending our health care money? We should be having that discussion, all the time, all over the place. But we should also cover the kids.
relevance in this venue allow me to point out that in some future date by some world court decision additional money for depleted uranium remedidations and clean up might be due and payable to the people of Iraq. Certainly it may deplete funds targeted for insuring American kids.
we’ve been using DU in the region since the 1st gulf war. since some of our soldiers have suffered from exposure effects after only relatively brief tours of duty, i can only imagine what the effects are/will be on the populations that live among the debris.
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will justice be served at the world court? perhaps. but the u.s. has a knack for not recognizing the validity extra-territorial courts. of course, that could change when bush is deposed.
…it was reported several years ago that Dr. Mengele–sorry, Henry Kissinger–has to take care of which other countries the goes to in the world for fear that he might be taken into custody and be sent to The Hague or trial for war crimes and crimes against humanity regarding Vietnam. I’m sure that Rummy will also take similar precautions, and GWBush after he leaves office.
…it was because the US leaders did not want to subject themselves to jurisdiction of the International Criminal Court (Den Haag) that the US refused to ratify the ICC treaty. They hid behind the grunt-soldiers-skirts, with the idiotic argument that the grunt soldiers were likely to be indicted for war crimes, not them, in their refusal to ratify.
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But that doesn’t mean that, if they travel to countries that have ratified the ICC, that they cannot be taken into custody and shipped off to Den Haag.
…if you are referring to Vietnam, it was Eisenhower who authorized the program.
Here ya go.
…from your cited article
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The documents give no indication whether a radiological weapon for targeting high-ranking individuals was ever used or even developed by the United States. They leave unclear how far the Army project went. One memo from December 1948 outlined the project and another memo that month indicated it was under way. The main sections of several subsequent progress reports in 1949 were removed by censors before release to the AP
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I was unaware that the lack of evidence regarding use of radiological weapons was evidence that they had been used.