In this fifth annual Cover the Uninsured Week, it is notable that organizers of the event are focusing on the State Childrens Health Insurance Program, including a $3 million TV ad campaign to point out the successes of the program and the need to cover more children. As a state/federal partnership, SCHIP has succeeded because states have had the flexibility to design creative programs that join SCHIP, Medicaid and other services to give millions of families the relief of having access to needed healthcare.
Now SCHIP is serving as a cornerstone of ambitious health coverage expansion plans in more than a dozen states. Earlier this month, the National Governors Association adopted a new policy on SCHIP, calling on Congress to provide adequate, predictable funding and enhanced flexibilities for states that will allow improvements in healthcare and coverage for children.
Unfortunately, there is no agreement between the two parties in Congress on the program, as you can see in the commentaries in this issue (p. 24). Many Republicans and the Bush administration want to cap it as a program strictly for the lowest-income children. They see adding parents and other adultsnot to mention children in families earning more than twice the poverty rateas an end run around the original intent of the program.
Though a proponent of expansion, I have to see the logic in the administrations stand. But given that any other efforts at the federal level to help the uninsured stand zero chance of passage, SCHIP is all we have. Covering more than 6 million kids at $5 billion per year has been a marvelous achievement for a federal program. Expanding it modestly would seem to provide a solid return on investment.
As SCHIP has shown, all of the innovation is now at the state and even local level, as this weeks cover story by Jessica Zigmond reveals. The coalition providing free-care clinics in Oklahoma City could be an example for other cities and health systems that they can work together to do something practical to address the issue of the uninsured.
Earlier this month, Massachusetts made key refinements to its universal coverage program. It expanded subsidies to provide free or cheaper coverage to another 52,000 of the states 328,000 uninsured. It persuaded insurers to trim health insurance rates charged to those who dont qualify for state subsidies. Although individuals earning $30,630 to $50,001 annually would not be eligible for state subsidies, now they would not be penalized if they could not find health insurance priced at $150 per month for an individual and $300 for families.
The biggest remaining stumbling block is whether copayments and deductibles of up to $10,000 for a family will be affordable for someone earning $40,000 who has to pay rent and expenses for children in a high-cost state.
In Washington state, the House and the Senate have passed different bills that would answer part of Gov. Christine Gregoires call for universal coverage by 2012. In California, debate continues on competing plans for universal coverage. And in Tennessee, a much more limited new program provides up to $25,000 in annual subsidies for healthcare for uninsured residents.
It is clear the states are tired of waiting on Washington, which even has trouble deciding what to do with a program that works.