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
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
G enevieve Kenney
The Urban Institute
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
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
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
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
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
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
Federal budget situation
State efforts to reach universal coverage
Federal health care reform proposals to address issues
with employer-based coverage
9
2
0
