Its a crapshoot as to whether the Senate Finance Committee will be able to get its act together and vote on a bill this week to reauthorize the State Childrens Health Insurance Program.
Finance Committee Chairman Max Baucus (D-Mont.) seems confident that the committee will be able to draft and vote on a bill this week to reauthorize the federal-state health program that was created in 1997 and sunsets in September. Covering children is a bipartisan issue we can all agree on, Baucus told reporters after a bipartisan meeting with Senate Finance Committee members last week.
At deadline, however, the bills language was still being negotiated, and Sen. Chuck Grassley (R-Iowa), the panels ranking member, seemed less confident that a vote was imminent. The legislation has yet to be evaluated for its budget impact, and there are still a lot of things that need to be worked out, he told reporters.
Its anyones guess whether the vote will take place this week, said Cindy Mann, executive director for the Center for Children and Families at Georgetown University. Theres a lot of discussion going on, negotiations among the Finance Committee members and other members of the Senate, she said.
SCHIP in fiscal 2006 covered 6.7 million children and more than 700,000 adults, according to the CMS. The original bill provided $40 billion to fund the program over 10 years, but emergency funding was recently provided to some 14 states that ran out of available SCHIP money. Its clear that more money is needed to meet the objectives of the program, Mann said. How much more remains the big question.
If Congress continues to cover the program under the current level, SCHIP could lose close to 2 million children that are already covered over the next five years, plus lose out on the opportunity to cover an additional 2 million children that are eligible under the current rules but not yet enrolled, Mann said.
The reauthorizing committees could draw from several bills in the House and Senate to craft the legislation. Each offers slight variations on coverage options, eligibility and additional funding. Sens. Hillary Rodham Clinton (D-N.Y.) and John Dingell (D-Mich.) in their legislation propose to expand the eligible federal poverty level to 400%, whereas a bipartisan bill from Sens. Jay Rockefeller
(D-W.Va.) and Olympia Snowe (R-Maine) would cover children up to 300% of the poverty level and, in some cases, 350%.
Legislation from the Illinois delegationRep. Rahm Emanuel (D-Ill.) and Sen. Dick Durbin (D-Ill.)wouldnt raise the poverty level, but all of the bills make an attempt to cover pregnant women. The Clinton-Dingell bill is the only one that proposes to cover more adults; it would add a new provision allowing states to cover adults through age 25. Currently SCHIP covers a variety of adults, including some pregnant women, parents of enrollees and childless adults.
Sens. Edward Kennedy (D-Mass.) and Orrin Hatch (R-Utah), sponsors of the original SCHIP legislation, also weighed in, releasing a set of principles last week that they hope will factor into the Senate Finance Committees negotiations on reauthorization.
The proposal supports an increase in the tobacco tax to pay for the legislation, in addition to new and innovative outreach efforts to get more children enrolled in the program. Mann noted that no one bill seems to be the basis for a reauthorization plan just yet.
Funding sources and continued expansion of the program to adults remain the biggest areas of contention, said Ron Pollack, executive director of Families USA.
Ten states currently provide coverage for parents, something they were able to do through a special federal waiver process, Pollack said.
But Grassley and others want to limit adult coverage, as does the Bush administration, which is ironic, because the administration is the very group that approved these parental coverage eligibility rules in the states. Now its saying its inappropriate to expand the program to more adults, Pollack said.
Sen. Kent Conrad (D-N.D.), a member of the Senate finance panel, opposes covering more adults. If were talking about covering children, then thats what we need to do, he told reporters last week. If were covering adults, we need to call it something else because otherwise its misleading.
Raising the federal poverty level for SCHIP above its standard level of 200% is another tricky issue, he continued. Some congressional Democrats believe the poverty level threshold should be raised to include more children, although the Bush administration proposed to limit eligibility to children at or below 200% of the federal poverty level. A poverty level of 300%, for example, would equal about $60,000 a year for a family of four, Conrad said. For a family in North Dakota, thats not poverty, but the situation would be different for a family living in New York, Conrad said.
Theres been some debate about whether to limit state flexibility and impose a federal cap on the income level of the children they could cover, even though a growing number of states are moving in this direction in light of the healthcare affordability crisis for Americas families, Mann said. At least 18 states, through SCHIPs flexibility provisions, have eligibility thresholds of more than 200% of poverty, she added.
In a letter to the Senate Finance Committee last week, the National Governors Association wrote that reauthorization should not diminish states flexibility to cover certain populations under current law or through federally approved waivers. It is important that the program allow governors room within which to establish coverage policies that work best in their state, the letter stated.
Congress recently approved a budget blueprint that funds SCHIP at $50 billion above its current baseline funding over five years. Overpayments to Medicare Advantage plans, plus a tobacco tax, remain two potential options for offsetting new SCHIP funds.
In Pollacks view, you cannot achieve the goal of meaningfully expanding coverage without some combination of those two things. Medicare Advantage was created to save money and provide coordinated managed care but instead has been converted into a huge feeding trough for the insurance companies, whose overpayments will cost roughly $55 billion over the next five years, he said.
Karen Ignagni, president and CEO of Americas Health Insurance Plans, responded that it was wrong to pit SCHIP and the Medicare Advantage plans against one another. On the Medicare Advantage side, theres a number of beneficiaries who receive stop-loss care, coordinated care and preventive care through the program and would have something to say about any potential cuts, she said.
The plans have been criticized for getting paid 12% more than traditional fee-for-service Medicare. The Congressional Budget Office estimates that capping Medicare Advantage at 150% of fee-for-service rates beginning in 2008 would save $2 billion over five years, and $4 billion over 10.
However, no decisions on offsets for SCHIP have been announced as yet, said a Baucus aide.
Pollack said the Senate is more likely than the House to attempt a clean reauthorization bill. The House has two authorizing committees of jurisdiction, Energy and Commerce and Ways and Means, and their members are going to want to make some improvements to things like Medicare, he said.