Bac kg ro und o n the State C hildren’s Health
Insuranc e Pro g ram
THE URBAN INSTITUTE
The Em plo y er-based Health C are
Sy stem -Shifting Respo nsibilities:
SC HIP atReautho riz atio n
ƒ SCHIP is up for reauthorization in 2007
ƒ SCHIP was created in August 1997 to address coverage
gaps among low-income uninsured children not eligible
for Medicaid
ƒ SCHIP is a block grant with a higher federal match rate
than under Medicaid
G enevieve Kenney
The Urban Institute
ƒ Anti-crowd out provisions were included in the statute;
no wrap-around benefits, option of creating premium
assistance programs
National Health Policy Conference
February 12, 2007
ƒ States had flexibility over their program structures,
eligibility, benefits, cost sharing, crowd-out prevention,
and enrollment limits
2
C hang es in Health Insuranc e C o verag e o f
Lo w -Inc o m e Adults and C hildren, 2000 to 2004
Share w itho utHealth Insuranc e C o verag e atthe
Tim e o f Interview , by Ag e G ro up: 1997 -2003
100%
25.0%
Perc entag e Uninsured
Adults
15.0%
18 .7 %
18 .9%
20.0%
18 .2%
13.9%
17 .8 %
20.1%
19.1%
8 0%
18 .3%
2000
2004
60%
12.7 %
12.3%
11.8 %
11.0%
10.5%
44.7 %
10.1%
10.0%
40%
C hildren
36.5%
36.1%
33.9%
37 .6%
40.3%
30.6%
29.7 %
21.9%
5.0%
16.1%
20%
17 .9%
19.5%
0.0%
1997
1998
1999
2000
2001
2002
2003
0%
Y ear
Adults
Adults
Kids
Adults
ESI
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
M edic aid/SC HIP
Adults
Kids
Uninsured
Source: S Zuckerman and A Cook. “The Role of Medicaid and
SCHIP as an Insurance Safety Net.” Washington, DC: The
Urban Institute. August 2006.
4
Insuranc e C o verag e am o ng C hildren
W ho Q ualify fo r SC HIP Based o n Inc o m e
M o stSC HIP Enro llees Do No t
Have Ac c ess to ESI
Uninsured
15%
100.0%
2.0 m illio n
a
8 0.0%
Other
6%
0.8 m illio n
60.0%
40.0%
Kids
Children
SC HIP
29%
3.9 m illio n
32.7 %
24.7 %
20.0%
0.0%
Share W ho Have atLeastOne
Parentw ith 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 W ho Have One Parent(in
One ParentF am ilies) o r Tw o
Parents (in Tw o ParentF am ilies)
w ith ESI
ESI
50%
6.6 m illio n
5
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
1
G ap Betw een Available F ederalF unds and
Spending Has Been G ro w ing
Lo o m ing F ederalF unding Sho rtfalls
7 .0
SC HIP Spending
6.4 *
6.0
Do llars in Billio ns
5.5
5.1
5.0
5.0
ƒ 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
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
SC HIP Allo tm ent
3.2
ƒ 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)
2.7
2.0
1.9
1.0
0.0
0.9
ƒ 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)
0.1
1998
1999
2000
2001
ƒ 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)
2002
2003
2004
2005
2006
2007
Y ear
Source: Congressional Research Service (CRS) analysis and CRS SCHIP Projection Model
* Projected Spending Level
7
8
SC HIP atReautho riz atio n
ƒ Federal budget situation
ƒ State efforts to reach universal coverage
ƒ Federal health care reform proposals to address issues
with employer-based coverage
9
2