Children's Health Insurance

Congress Struggles With Who to Cover, How Much to Spend

Funding for the $5 billion-a-year Children's Health Insurance Program, a popular federal-state partnership that provides health coverage to about 6 million kids, is shaping up as a budget battle in Congress. The nonpartisan Congressional Budget Office says the program needs the current $5 billion a year funding, plus another $13 billion to $15 billion over the next five years, just to keep covering the same number of children. President Bush has other ideas. He wants to add only $4.8 billion over five years -- on top of continuing the current $5 billion a year budget -- and says the program should focus only on the neediest kids. Some Democrats want to increase the current funding level by as much as $50 billion over the next five years in order to extend coverage to more children, as well as some parents and childless adults. The program, which began in 1997, must be renewed by the end of September.

Post writer Christopher Lee was online Monday, March 5 at 1 p.m. ET to take questions and comments from readers on CHIP and other children's health insurance issues.

Children's Health Care on Agenda (Post, March 4)

The transcript follows.

____________________

Christopher Lee: Hello everyone, thanks for tuning in to this discussion of the Children's Health Insurance Program and its future. Do you support this program? Who has the right idea about new funding for it -- President Bush or the Democrats who control Congress? Anyone out there have any personal experience with the program in their state? If so, let us know how it's working and how it isn't. Let's get started.

_______________________

Washington, D.C.: As someone who has worked to help children enroll in SCHIP, it never ceases to amaze me how low politicians stoop. These funds for CHIP were meant for children. Many states took these funds to help cover adults and now they are complaining about being out money -- how can they get away with stealing from the children?

Christopher Lee: As we noted in our story today, 14 states cover not just children in their programs but adults as well -- about 639,000 adults are enrolled across the country, according to the Government Accountability Office. In some cases these folks are pregnant women, in others they are parents of children enrolled in the program, and a few states cover some childless adults. It's also true that some of these states say they are running short of money -- but there are other states that stick to covering children only that are short on funds.

The states that cover adults got permission from the federal government to do so, so they aren't renegades -- they are living with the rules. One question Congress faces is whether to change those rules so that the program focuses more tightly on children.

_______________________

Atlanta: We're one of the SCHIP budget shortfall states -- the Governor and legislature are waiting for Congress to reauthorize SCHIP as well as fund the $131 million shortfall. In the meantime, legislators are looking for ways to maintain the program while cutting eligibility and services. I'm reading the news and getting a lot of conflicting messages -- it seems that everyone wants to expand health coverage for children but no one wants to pay for it.

Christopher Lee: Hi Atlanta. Your Republican governor, Sonny Perdue, has been a pretty vocal proponent of getting more funding for the program ASAP. It shows that the partisan divisions on funding in Washington break down when it comes to the states: governors of both parties want Washington to step up and put more money into the program. But you're right -- everyone wants to expand health coverage. That part is easy, it's finding the money for it that's hard.

_______________________

Seattle: What reasons do states that offer SCHIP funds to insure childless adults give to justify the allocation of those funds? I can understand enrolling pregnant women and even parents (because evidence suggests enrolling the family leads to better care), but using SCHIP funds to insure parentless adults -- while a noble goal -- seems beyond the scope of the program's mandate.

Christopher Lee: You touched on some of the reasons -- pregnant women need health care before the baby arrives if that baby is to have the best chance of being healthy. Some studies show that covering parents as well as children helps ensure that the kids get the care they need, and that the whole family is healthy. As for childless adults, well, that probably is the most controversial element of the debate. In general, proponents view the program as a powerful way to extend coverage to people who don't have it -- and there are about 47 million uninsured Americans these days, including 8.3 million kids. Some in Congress, and certainly President Bush, think it's a bit much to ask the CHIP program to cover childless adults, though.

_______________________

Vienna, Va.: Isn't one of the reasons SCHIP is so popular among Republican and Democratic governors because they get more services than they have budget for? And isn't it also true that some states are spending the money on adult health care even though it's a children's program?

Christopher Lee: You're right on both counts. The CHIP program, like Medicaid, is paid for by both the federal government and the state governments, but while the federal government's average share of Medicaid spending is 57 percent, it is 70 percent under CHIP. That's a much better deal for the states, and it makes the program popular with governors of both parties. And politicians of all stripes will tell you that ensuring that children have health coverage is one of their most important jobs.

_______________________

Silver Spring, Md.: I was saddened and disgusted by The Washington Post report last week about the completely preventable death of twelve-year-old Deamonte Driver. Members of Congress have been giving plenty of lip service to children's health -- but they are balking at the types of measures that are truly needed. Not only are there more than 9 million children without health insurance, there are nearly 30 million children currently with Medicaid or SCHIP health insurance that cannot find a health care provider -- dentists, mental health providers, and other specialists are especially difficult to find. Parents and their children must wait months for an appointment with a doctor. Shouldn't Congress make Medicaid- and SCHIP-covered children's access to critical health care services a priority when they reauthorize SCHIP? There is a simple way to improve the dire situation: raise provider reimbursement rates!

washingtonpost.com: Boy's Death Fuels Drives to Fund Dental Aid to Poor (Post, March 3)

Christopher Lee: The reader touches on a very powerful and disturbing story written by my colleague Mary Otto last week about a young boy who died after bacteria from an infected tooth spread to his brain. It all might have been avoided if he had had adequate dental care.

_______________________

Childless Adults: Those Childless adults often are adult dependents -- in many cases they are developmentally delayed or impaired and in effect are children. Seriously, this isn't Lawyer John scamming the system that we're talking about.

Christopher Lee: Thanks for writing in.

_______________________

Washington, D.C.: SCHIP from the outset has been a political kickball. Can you give some background regarding it's creation. Under what committee(s) does it fall, in terms of oversight? From your piece it seems as though certain congressmen (whose health care is covered by their employers, I would add) are ready to throw the baby out with the bathwater, by citing some programmatic oddities that in fact may be well within the intent of SCHIP.

Christopher Lee: The program was created in 1997 as part of the Balanced Budget Act. The federal government agreed to put up $40 billion over 10 years with the goal of providing health insurance coverage to children from families that earned too much to qualify for Medicaid but still couldn't afford health insurance on their own. The guideline was to try to cover children in families at up to 200 percent of the poverty level (which works out to about $41,300 for a family of four in 2007). But the legislation allowed states to apply to the Health and Human Services secretary for "waivers" that would enable them to do things like cover parents and childless adults. It's worth noting that the Deficit Reduction Act, passed in February of last year, prohibits any new waivers to cover childless adults. The program has enjoyed bipartisan support over the years -- the general consensus on Capitol Hill is that it is sure to be reauthorized this year, the question is at what funding level.

_______________________

Arlington, Va.: Don't people pay premiums for the SCHIP coverage?

Christopher Lee: In general yes they do, though the amount varies by state and income level, and in some cases a premium is not required.

_______________________

Massachusetts: Our organization just released a poll that shows overwhelming support for increased funding for SCHIP among New England voters. In the poll conducted by Lake Research Partners, 89 percent supported expanding SCHIP to cover all uninsured children and 89 percent supported covering low-income parents if their jobs do not offer health insurance. SCHIP is a successful federal-state partnership. In the New England states, there is strong support for expanding coverage. Amy Rosenthal, New England Alliance for Children's Health

washingtonpost.com: Too Close to Turn Back: Covering America's Children (.pdf) (Georgetown University, Dec. 12, 2006)

Christopher Lee: I'll post this without comment.

_______________________

Pennsylvania: I work in a NICU and it is absolutely amazing how many babies are admitted without insurance for myriad reasons. These kids still get care, of course, but the true challenge seems to be them getting the level of care many of them require after discharge. Both state-funded and private insurers have made it clear that most children, especially those with ongoing skilled medical needs, are underinsured. To Washington, who had concerns about adults receiving coverage -- I agree that it seems unfair to provide coverage to adults out of funding earmarked for CHIP, but covering pregnant women only benefits everyone in the long run -- babies are born healthier and require less medical care when moms have good prenatal care.

Christopher Lee: Thanks for sharing your experience.

_______________________

Virginia: Can my kids enroll in CHIP if I have Blue Cross insurance?

Christopher Lee: The short answer is that I don't know, but when in doubt apply anyway and see what they say. At the very least you should inquire about this. This link (below) should take you to the home page for Virginia's CHIP Program -- the Family Access to Medical Insurance Security plan (FAMIS). Good luck.

_______________________

Re: Dental Care: I think it's simplistic to say that raising provider rates will get poor kids better health care. First of all, I think everyone has to realize that there is just a limited supply of funding for health care. So, if you pay twice as much for services, you only can insure half as many people. We simply can't afford to pay to have any possible service or medication covered for everyone in the country. Heck, I have good medical insurance and typically I have to wait more than a month to get an appointment for a doctor or dentist. Also I think poor kids just have a lot of problems that go together, which makes it hard to give them adequate medical care. My understanding is that when they do make appointments, they only keep the appointment about 20 percent of the time -- that's a time slot that the dentist/doctor can't fill with another most likely patient, so lost money for them. And they can't just charge the poor person for the missed appointment, as they do with everyone else -- or, if you allow that, now it's going to cost five times as much to insure the poor. The problems of the poor typically are resistant to simplistic answers.

Christopher Lee: Another view. Thanks for writing in.

_______________________

Walkersville, Md.: Hello -- I am a mother of four children all of whom are covered by CHIP. I recently have testified in both the U.S. Congress and the Maryland State Legislature about CHIP and expanding Medicaid here in Maryland to cover parents. As someone who needs and uses the program, I wholehearted say that the funds should first be used to cover all uninsured children before adding parents to the program -- but if funds can be found, parents need coverage to, as healthy parents are better able to keep their children healthy.

Christopher Lee: Thanks for sharing your experience, Walkersville.

_______________________

Tysons Corner, Va.: But in some cases haven't the CHIP guidelines grown pretty rich -- up to 300 percent of poverty? While that's not wealthy it is in many instances within reach of some major medical insurance policies. I'm sure there are examples of cases where it's not but at some point don't we need to have some cost control of what we're spending?

Christopher Lee: Yes -- and this is something that many Republicans point to in arguing that the program is expanding beyond its original intention. Seven states cover children from families that earn as much as 300 percent of the poverty level (about $61,950 for a family of four in 2007). New Jersey is the most generous, covering kids from families earning as much as 350 percent of poverty ($72,275). New Jersey officials argue that the cost of living in their state is higher than in most others, so it makes sense to cover children from higher income levels. President Bush has said the CHIP program should focus its resources on children at or below 200 percent of poverty.

_______________________

U.S.: Have there been studies done to show whether children enrolled in these health care programs are more successful as adults? We're spending a lot of money on SCHIP -- is it meeting any long-term goals, or is it just a way to provide health insurance to poor kids?

Christopher Lee: I don't know of any studies about how programs like CHIP affect people once they grow into adulthood, but there is plenty of evidence that children without health insurance fare worse in many ways than those who have it.

Children without health coverage are three times as likely as insured children to lack a regular doctor, according to a report released last month by the Robert Wood Johnson Foundation. Research from the American College of Physicians in 2000 found that uninsured children were less likely to be up-to-date on immunizations or to receive treatment for sore throats, earaches and other common childhood illnesses. A University of Texas study found that kids with insurance tend to have fewer school absences.

_______________________

Re: Childless Adults: Well, just as I expected, the childless adult is the evil pariah. As a childless adult without an employer who pays health insurance premiums, I pay almost $500/month for coverage. I'm also a professional and can afford it, although I'd rather put it away for retirement. A lot of adults don't make the kind of salary I do, and I think it's heartless for those without marketable skills to be denied coverage just because they're single. When they do get sick it will take thousands to remedy problems it could have taken a lot less to correct.

Christopher Lee: Here is the perspective of a childless adult.

_______________________

Christopher Lee: Well, the big hand is on the 12 and the little hand is on the 2, so it's time to close this discussion for now. Expect to see a lot of activity on this topic in Congress in the next few weeks and months -- it's a high priority for the Democrats who now control Congress. Thanks to all the chatters for participating.

_______________________

Editor's Note: washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.