The Employer-based Health Care
System - Shifting Responsibilities:
SCHIP at Reauthorization
Genevieve Kenney
The Urban Institute
National Health Policy Conference
February 12, 2007
Background on the State Children’s Health
Insurance Program
 SCHIP is up for reauthorization in 2007
 SCHIP was created in August 1997 to address coverage
gaps among low-income uninsured children not eligible
for Medicaid
 SCHIP is a block grant with a higher federal match rate
than under Medicaid
 Anti-crowd out provisions were included in the statute;
no wrap-around benefits, option of creating premium
assistance programs
 States had flexibility over their program structures,
eligibility, benefits, cost sharing, crowd-out prevention,
and enrollment limits
2
Share without Health Insurance Coverage at the
Time of Interview, by Age Group: 1997-2003
25.0%
Percentage Uninsured
Adults
20.0%
15.0%
18.7%
18.9%
18.2%
13.9%
12.7%
17.8%
19.1%
20.1%
18.3%
12.3%
11.8%
11.0%
10.5%
10.0%
10.1%
Children
5.0%
0.0%
1997
1998
1999
2000
2001
2002
2003
Year
Adults
Children
Source: JS Schiller, M Martinez, P Barnes. Early release of selected estimates based on data from the 2005 National Health
Interview Survey. National Center for Health Statistics. http://www.cdc.gov/nchs/nhis.htm. June 2006.
3
Changes in Health Insurance Coverage of
Low-Income Adults and Children, 2000 to 2004
100%
80%
2000
2004
60%
44.7%
40%
36.5%
36.1%
33.9%
29.7%
37.6%
40.3%
30.6%
21.9%
16.1% 17.9%
20%
19.5%
0%
Adults
Kids
ESI
Adults
Kids
Medicaid/SCHIP
Source: S Zuckerman and A Cook. “The Role of Medicaid and
SCHIP as an Insurance Safety Net.” Washington, DC: The Urban
Institute. August 2006.
Adults
Kids
Uninsured
4
Most SCHIP Enrollees Do Not
Have Access to ESI
100.0%
80.0%
60.0%
40.0%
32.7%
24.7%
20.0%
0.0%
Share Who Have at Least One
Parent with ESI
Source:
Source:GKenney
Kenneyand
andCook,
A Cook.
2007
“Coverage Patterns Among
SCHIP-Eligible Children and Their Parents.” Health Policy Online
No. 15. Washington, DC: The Urban Institute. February 2007.
Share Who Have One Parent (in
One Parent Families) or Two
Parents (in Two Parent Families)
with ESI
5
Insurance Coverage among Children
Who Qualify for SCHIP Based on Income
Uninsured
15%
2.0 milliona
Other
6%
0.8 million
SCHIP
29%
3.9 million
ESI
50%
6.6 million
Source: G Kenney and A Cook. “Coverage Patterns Among
SCHIP-Eligible Children and Their Parents.” Health Policy Online
No. 15. Washington, DC: The Urban Institute. February 2007.
6
Gap Between Available Federal Funds and
Spending Has Been Growing
7.0
SCHIP Spending
6.4*
6.0
Dollars in Billions
5.5
5.1
5.0
5.0
4.6
4.3
4.3
4.3
4.3
4.0
4.3
4.1
4.1
3.8
3.2
3.0
3.2
SCHIP Allotment
3.2
2.7
2.0
1.9
1.0
0.0
0.9
0.1
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Source: Congressional Research Service (CRS) analysis and CRS SCHIP Projection Model
* Projected Spending Level
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Looming Federal Funding Shortfalls
 Funding problems are more acute in some states than in others; a
growing number of states are projected to face shortfalls in the coming
years and funding uncertainties may limit state expansions (Peterson
2006)
 Despite $4 billion accumulated in unspent funds, a number of states will
face federal funding shortfalls by May 2007, and Georgia is slated to face
a shortfall even earlier
 CBO baseline includes an annual federal funding level of $5.0 billion. At
that funding level, SCHIP enrollment is projected to fall from 4.4 to 3.1
million over five years (HHS 2006)
 An estimated $12.7 to $14.6 billion in additional funds would be needed to
maintain programs at current levels through 2012; even more is needed
to cover remaining eligible uninsured children or other groups (e.g. lowincome parents), but would require offsetting savings elsewhere in the
budget (Broaddus and Park 2006; Peterson 2006)
8
SCHIP at Reauthorization
 Federal budget situation
 State efforts to reach universal coverage
 Federal health care reform proposals to address issues
with employer-based coverage
9