Policy Priorities

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How Are Children Faring in Health Reform?

U.S. Capitol

March 2010 Legislative Update

March 26, 2010

Late last night the House of Representatives cast a final vote on a package of ‘fixes’ to seal the deal on this chapter of health care reform.  After hours of debate over hundreds of amendments, the Senate passed the bill earlier in the day, though had made a few small changes, requiring the final vote by the House last night.  The President is expected to sign the bill very soon.  And so the next phase of very hard work now begins – that of enrolling all those who are eligible through every possible means at the federal, state and local levels.  But for now, we bask in a huge step forward after a very hard fought series of battles. You helped make it possible and we thank you. Millions of children will be better off because of what you did.

March 23, 2010

On March 21, the U.S. House of Representatives passed landmark health reform legislation that will guarantee access to health coverage for 32 million people in America, including more than 95% of all children.  This morning President Obama signed the first part of this important legislation and the Senate will begin debate on another part today.  With the passage of these new health reforms, Congress and the President have taken giant steps towards ensuring affordable and comprehensive health coverage for all children and families in America.  It would not have happened without the help of many across the country. 

The legislation, once both parts are signed, will:  

• Guarantee access to health coverage for 32 million people in America including more than 95% of all children;
• Cover millions of low income parents and other adults in Medicaid; 
• Maintain the Children’s Health Insurance Program (CHIP) until it is determined that the new “health insurance exchanges” are safe for children and provide them benefits and cost protections comparable to or better than they have now; 
• Fund CHIP through 2015 – doubling the number of eligible CHIP children that can be served from 7 to 14 million;
• Prevent insurance companies from unjustly denying coverage because of pre-existing conditions or annual or lifetime limits (eliminating pre-existing conditions for children will take effect immediately); and
• Extend coverage for youths in foster care and youths with private insurance to age 26.

Our job now, once the Senate acts later in the week, will be to ensure that children and families truly benefit from these new reforms.  We are counting on you to make sure they do!

March 17, 2010

The U.S. House of Representatives will vote this week on a groundbreaking health reform bill that will guarantee access to health coverage for 31 million people in America, including more than 95% of all children.  CDF and many others have spent decades slowly filling in gaps in our health care system, covering the uninsured age group by age group, category by category, state by state.  The health reform bill is an enormous step forward in finishing the job and insuring all children.  This week is also Cover the Uninsured Week, bringing awareness to the magnitude of the problem and its consequences.  The health reform bill will:  

• Guarantee access to health coverage for 31 million people in America including more than 95% of all children;
• Cover millions of low income parents and adults in Medicaid; 
• Maintain the Children’s Health Insurance Program (CHIP) until it is determined whether the new “health insurance exchanges” are safe for children and provide them benefits and cost protections comparable to or better than they have now; 
• Fund CHIP through 2015 – doubling the number of eligible CHIP children that can be served from 7 to 14 million;
• Prevent insurance companies from unjustly denying coverage because of pre-existing conditions or annual or lifetime limits (eliminating pre-existing conditions for children will take effect immediately); and
• Extend coverage for youths in foster care and youths with private insurance to age 26.

Powerful insurance companies and other special interests are spending millions of dollars to block this lifesaving and cost saving bill that tens of millions of children and adults and our whole nation desperately need now. 

A new report from the Robert Wood Johnson Foundation released during Cover the Uninsured Week highlights just how dire the situation is.  It finds that the recent economic downturn has taken a tremendous toll on people’s ability to afford health insurance and  employers’ capacity to offer it. The report shows America’s middle class has been hardest hit, becoming uninsured more quickly than those groups earning both more and less.  From 2000 to 2008, the average cost an employee paid for a family insurance policy rose 81 percent while median household income fell 2.5 percent. 

Earlier this week, CDF President Marian Wright Edelman’s joined Speaker of the House Nancy Pelosi and other children’s advocates for a press conference to highlight the gains for children in this legislation.  See her remarks here.  This bill will take tremendous strides towards comprehensive health coverage for all children, and will give more than 95% of the children in America a chance for a healthy start in life.  Stay tuned!

February 2010 Legislative Update

February 24, 2010

On Monday, February 22nd, President Obama released his proposal for health reform, “Putting Americans In Control of their Health Care.”  Drawing from health reform bills earlier approved by the House of Representatives and the Senate, the President outlined a number of policies he wants included in a final health reform bill to make health insurance more affordable for all Americans.  It is very good news for children that the President follows the Senate’s lead and preserves the Children’s Health Insurance Program (CHIP) through FY 2019 and extending funding for this important child health safety net for an additional year through FY 2016. The expansion of Medicaid to individuals at or below 133 percent of the federal poverty level will also make millions of additional children and parents eligible for coverage. Some simplifications in the enrollment process for CHIP and Medicaid were also included. The proposal also includes many important insurance market reforms to assist children and adults, the creation of subsidies to help many families purchase affordable coverage, a health insurance exchange, a mandate for health coverage, and other improvements to the health care delivery system. 

Tomorrow, the leadership in the House and Senate will meet with President Obama in a bipartisan summit to discuss additional ideas for making our health care system work better for all. We need health reform now so millions of children and families will be better off!

February 4, 2010

Happy Anniversary CHIP!

One year ago today, February 4, 2009, our newly elected President, Barack Obama, signed into law the Children's Health Insurance Program Reauthorization Act (CHIPRA). On that day he reminded us that the Children's Health Insurance Program (CHIP) has been "a lifeline for millions of kids whose parents work full time, and don't qualify for Medicaid, but through no fault of their own don't have—and can't afford—private insurance. For millions of kids who fall into that gap, CHIP has provided care when they're sick and preventative services to help them stay well." 

When signing CHIPRA, President Obama acknowledged it as "only a first step" and committed to "continue and build on these successes." With your support, the Children's Defense Fund and others around the country have taken up that charge and worked to build on CHIP in national health reform. We are optimistic that those gains will soon be realized. We must ensure that no child will be worse off after health reform than he or she is now and that child health coverage is accessible, comprehensive and affordable.

At the same time the push for national health reform continues, there is hard work being done in states to ensure that many of the children who are eligible for CHIP, but are not enrolled, will get the coverage they need. We are moving in the right direction; in 2008, the number of uninsured children dropped to its lowest point in 20 years, even as uninsurance rates for adults continued to rise. As President Obama himself said, CHIP is working. In 2009, despite challenging economic times, half of the states expanded CHIP coverage.

Check CDF's Children’s Health Coverage State Fact Sheets to learn more about how CHIP works in your state.

The Georgetown Center for Children and Families also is tracking CHIPRA implementation activities in the states.

Contact the agency that administers the CHIP Program in your state to find out how your faith community, schools in your community, and other community organizations you are involved with can help to get children enrolled in health coverage.

Increasing child enrollment in CHIP will benefit both children and families and states; children enrolled in CHIP will get the health coverage they need to succeed in school and in life; and states are eligible for Federal bonuses for significant increases in the number of insured children. 

January 2010 Legislative Update

January 15, 2010

Thanks to the good efforts of so many inside and outside Washington, Sen. Bob Casey’s Children’s CHIP Amendment garnered a lot of attention in the Senate. Although there was never a vote on the amendment, Sen. Bob Casey (D-PA) and Senator Jay Rockefeller (D-WV) both championed the Children’s Health Insurance Program (CHIP) and thanks to their efforts, the Senate health reform bill that passed on Christmas Eve continues CHIP until 2019 and fully funds it through 2015. 

Key House and Senate leaders are now working to resolve differences between the House and Senate bills.  Important provisions for children must be preserved in order to protect millions of children from being worse off, rather than better off.  These include:

1) Keep the Senate provisions that preserve CHIP through 2019 with full funding through at least 2015 and require states to maintain at least their current levels of effort in CHIP.  The successful CHIP program should not be repealed in 2013 as the House bill proposes and children should not be turned over to a new exchange until it is shown to be a safe and better place;

2) Prevent CHIP eligible children from being moved in to the exchange until the coverage in the exchange is at least comparable to what they would get under CHIP.  An assessment must be done that compares benefits, cost sharing, adequacy of pediatric provider networks, quality of care, legal protections, barriers to enrollment and service utilization, interstate variation, and continuity of care for children in CHIP versus the exchange with an assurance that CHIP will not be eliminated until coverage is comparable; and

3) Maintain all enrollment simplification measures in both the Senate and House bills including the following:

a. Implementing “no wrong door” enrollment procedures;
b. Requiring that parents newly eligible for Medicaid cannot get Medicaid unless their children are insured;
c. Allowing child-only access to health plans in the exchange;
d. Providing for automatic 60 day enrollment of uninsured newborns in Medicaid;
e. Requiring 12 month continuous eligibility for certain children in CHIP;
f. Eliminating the asset test for children in CHIP and Medicaid; and
g. Prohibiting waiting periods in CHIP for certain groups of children.

There are many other provisions in the bills passed by the House and Senate that will improve health coverage for  millions of lower income children and families, such as maintaining the House provision increasing Medicaid reimbursement rates, expanding Medicaid to all individuals with incomes below 150% FPL, extending Medicaid to youths aging out of foster care to age 26, and the various insurance reforms, that must also be maintained.

To learn more about why we must keep CHIP, read a recent column by CDF’s President Marian Wright Edelman and another by our friend, Bruce Lesley, President of First Focus

December 2009 Legislative Update

December 22, 2009

As the Senate moves closer to passage of health reform, it's a good news, bad news story.  The good news is that the Senate is very close to a final vote on a health reform bill that will provide health coverage to more than 31 million currently uninsured children and adults, protect the Children’s Health Insurance Program (CHIP) until 2019 and fully fund CHIP through 2015.  This is much better than the House health reform bill that repeals CHIP in 2013.  The bad news is that despite your great efforts and the efforts of many supporters across the country millions of children will still be worse off if CHIP is not fully funded after 2015 and the new health insurance exchanges do not offer comparable benefits and protections. 

The challenge continues.  Our work is not done and help is still needed as a Conference Committee begins resolving differences between the House and Senate bills in early January.  We must ensure that the final health reform bill will make all children better off and leave no children worse off.

We so appreciate your outreach to your Senators urging their support of Senator Bob Casey’s (D-PA) Children’s CHIP Amendment.  More than 600 national, state and local, and faith organizations and Bishops signed a letter in support of the amendment.  Nine Senators joined Senator Casey as co-sponsors.  Unfortunately the amendment could not be voted on because it never received a cost estimate from the Congressional Budget Office (CBO).

As attention turns to resolving differences between the House and Senate health reform bills, it is critically important that the gains made for children in CHIP with the leadership of Senator Jay Rockefeller (D-WV) and Senator Bob Casey be maintained.  Children must not be moved out of CHIP until health coverage that is at least comparable to CHIP is available through the health insurance exchanges.  We were deeply disappointed that the critically needed improvements in CHIP to make coverage comprehensive, accessible and affordable no matter where children live were not included in the Senate bill.  We must still work to make it easier in the final bill for children to get CHIP and keep it.

We are so grateful for your continuing help and will need it again early in January.  We will get back to you then.  Have a joyous 2010!

December 11, 2009

During the Senate floor debate on health reform this week, Senator Casey made two strong floor statements about his Children’s CHIP Amendment.  In addition, he submitted for the record a letter of support from more than 600 national and state organizations – including advocacy organizations, civil rights groups and prominent members of the faith community.  A group of civil rights organizations, including CDF, the NAACP and NCLR, also sent a strong letter of support to Senator Casey, highlighting the ways in which the amendment will make an impact on communities of color and in addressing health disparities. 

You also may be hearing news about a potential extension of CHIP.  While the details are still emerging, it appears the Compromise Package Senate Democrats sent earlier this week to the Congressional Budget Office for scoring included a 2 year extension of CHIP (through 2015).  From what we can tell, it doesn’t include any of the critical improvements Senator Casey’s amendment makes that are important to ensuring health coverage that is affordable, comprehensive and accessible to millions of children. 

Check back next week as we await more news on the Compromise Package and look for Senator Casey’s amendment to be discussed further on the Senate floor.

December 8, 2009

As the health reform debate continues on the Senate Floor this week, today our friends at First Focus released a white paper entitled "Children in Health Reform: Comparing CHIP to the Exchange Plans" examining children’s coverage in CHIP that they would receive in the exchange plans if CHIP were to be eliminated.  The report found that on indicators such as covered benefits, out-of-pocket costs, premiums, access to pediatric providers, and the guarantee to care, that CHIP coverage is in fact better than the plans proposed in the exchange. The First Focus report supports the need to build on what works – protecting and strengthening CHIP as the Casey Children's CHIP amendment would do. We're still waiting for this amendment to be debated on the floor, so stay tuned!

December 1, 2009

Millions of children will be worse off than they are now if the House health reform bill becomes law. The House bill ends the Children’s Health Insurance Program (CHIP) in 2013 and would move as many as 10 million CHIP children to a new, untested and more expensive Health Insurance Exchange where their parents will pay more for fewer benefits. The Senate health reform bill being debated now keeps CHIP until 2019 but fails to fully fund it or make system improvements to ensure CHIP children get and stay enrolled and receive the care they need wherever they live. Senator Bob Casey (D-PA) has filed an amendment to the Senate health reform bill that would make children better off – not worse off! 

The Casey Children’s CHIP Amendment keeps and strengthens CHIP through 2019. It:

  • Guarantees funding for all children eligible for CHIP.  They will hen transition into the Exchange in 2019 if the coverage (including benefits, out-of-pocket and premium costs and other features) in the Exchange is comparable to CHIP.   
  • Makes CHIP more accessible. Offers financial incentives to states to eliminate barriers that currently prevent millions of CHIP eligible children from getting and staying enrolled. It would continue outreach and enrollment grants and make it easier to establish and verify eligibility for CHIP.
  • Ensures children the full range of health and mental health services they need.  These include the preventive and specialized services children receive in Medicaid.  
  • Establishes a national health care safety net for CHIP children. Coverage will be more affordable for children in families with incomes at or below 250 percent of the federal poverty level ($55,125 for a family of four) who will be eligible for CHIP no matter what state they live in. The 22 states and the District of Columbia that currently cover children in families above 250 percent also will be eligible for increased federal funding to help them cover CHIP children.  Families will be protected from paying significantly more out-of-pocket than they do today for health coverage for their children in CHIP. 
  • Invests in Vulnerable Children and Families. Half of all cost savings from the amendment will be invested in a Fund for Vulnerable Children and Families to combat infant mortality, assist low income children with autism spectrum disorder or other disabilities, and improve health and mental health services for children who are homeless and those in foster care. The remaining half will help to reduce the deficit.

November 2009 Legislative Update

November 20, 2009

On November 18, Senate Leadership released its much anticipated health reform bill. The Patient Protection and Affordable Care Act is a merged version of the health reform bills approved earlier by the Senate Finance and HELP Committees. The act incorporates some important health insurance reforms for children that were in the Committee bills. But it could still leave millions of children worse off. While the House bill repeals the Children's Health Insurance Program (CHIP) in 2013, the Senate Leadership bill keeps CHIP in place until 2019 (thanks to the leadership of Senator John D. Rockefeller IV in the Senate Finance Committee), but does not fully fund CHIP after 2013. This means that CHIP coverage for millions of children could be threatened in 2013, when some of these children could be shifted into a new untested Exchange before it is able to offer comparable benefits and cost-sharing protections – and many of these children could end up worse off.

Fortunately, Senator Bob Casey from Pennsylvania has indicated he will offer a Children's CHIP Amendment when the health reform debate begins in the Senate. This amendment will preserve, fund and strengthen CHIP to 2019, so children will be ensured health coverage that is comprehensive, accessible and affordable.

The Senate is expected to vote over the weekend on the procedural motions that are necessary to begin the health reform debate. Opening statements are expected to begin the Monday after Thanksgiving, and debate over amendments will follow. The debate on the Senate health reform bill is expected to take three to four weeks. So please stay tuned!

November 9, 2009

Late on Saturday, November 7, the House of Representatives passed the Affordable Health Care for Americans Act of 2009 (H.R. 3962) by a vote of 220-215, with all of the Republicans but one, and 39 Democrats voting against the bill.  The passage of this bill is an important step forward towards achieving national health reform.  Although the House bill would end the Children's Health Insurance Program (CHIP) and move most of the children in CHIP into a new, untested and more expensive Health Insurance Exchange, the bill also includes a number of provisions that will lead to an expansion of affordable coverage to millions of children and families.  It makes it impossible for insurance companies to deny coverage based on pre-existing conditions and eliminates lifetime caps on benefits—improving coverage options for millions, including children with disabilities and chronic illnesses.  The unprecedented expansion of Medicaid to persons with incomes at or below 150 percent of poverty will bring millions of low-income adults, including millions of parents, affordable coverage and move about 2.3 million children from CHIP programs into Medicaid where they'll be guaranteed a more comprehensive set of benefits and protected from high out-of-pocket costs.  In terminating the CHIP program, however, the House bill seriously threatens the health coverage of the millions of children who are projected to be enrolled in CHIP when the bill terminates the program in 2013.  We must work to continue to ensure that a final health reform bill will not leave any children worse off than they are today. 

Our focus now turns back to the Senate, where a final bill should be released very soon and then moved to the floor for debate, which could take three weeks.  Last week, Senator Casey made a firm public commitment to offer an amendment to the Senate bill that would ensure affordable, comprehensive coverage in a simple and seamless system for all children.  Senator Rockefeller also issued a statement last week indicating that he'll continue to fight to strengthen children's health coverage as the debate continues.  President Obama has repeatedly spoken about building upon what works—we can do this by building upon the current CHIP program so that all children will be better off after health reform.  

October 2009 Legislative Update

October 30, 2009

Yesterday, the House Leadership unveiled The Affordable Health Care for Americans Act of 2009 – its merged health reform bill.  While this bill made some important changes from the previous version, but did not go far enough in ensuring children will be better off after health reform. 

One of the most notable improvements is the expansion of Medicaid for all individuals up to 150% of poverty (compared to 133% of poverty as proposed in the earlier bills).  This is not only a huge gain for low-income adults, but also the approximately 2.3 million children who will now be eligible for the comprehensive Early Periodic Screening, Diagnosis, and Treatment (EPSDT) benefits to which all children in Medicaid are entitled. 

But even with this – and other improvements – the House bill that will go to the floor next week could still leave millions of children worse off after health reform than they are now.  The bill proposes to terminate the Children's Health Insurance Program (CHIP) in 2013 (when it would otherwise be up for reauthorization) and move children who had been receiving coverage in CHIP into the untested health insurance exchange without any real assurance that children will be guaranteed comparable or better comprehensive benefits and good cost-sharing protections that they now have in CHIP – the things that make coverage what children need and affordable for their families.  This transition from a program that is working to something new should not be made until it can be shown to provide coverage that is at least as good as what children have now – but preferably better.

The bill protects the more than a million children who are receiving coverage in the states that operate their CHIP programs as "Medicaid expansion programs," enabling them to remain eligible to for coverage through Medicaid (and therefore, the strong guaranteed Medicaid EPSDT benefit package and cost-sharing protections) after the CHIP program is terminated in 2013.  However, it does not ensure that children in other state CHIP programs have the same comprehensive benefits that children in Medicaid have – or that when CHIP is terminated children will be entitled to those benefits through the exchange.  This means that all children everywhere will remain subject to the "lottery of geography" that protects children in some states but not others. 

Finally, the House bill does little to address the state-imposed administrative barriers that now keep two out of every three of the more than 8 million uninsured children who are eligible for Medicaid and CHIP from getting coverage.  Health reform will be a hollow promise for children if they can’t get the coverage for which they are eligible!      

October 28, 2009

While Members of Congress are working behind closed doors this week to merge the various Committees' bills, child advocates continue the drum beat, working to ensure children are included in those discussions and that the bills we're likely to see on the House and Senate floors in the coming weeks will make children better – not worse – off after health reform.    

In the meantime, we wanted to share with you a couple of interesting new findings that highlight why we must not only keep the Children's Health Insurance Program (CHIP), but strengthen it until coverage in the exchange can be shown to be equal or better.  Recently our friends at First Focus commissioned a study to compare the affordability of CHIP to coverage for children in the exchange plans, as offered in both the House and the Senate proposals respectively.  They found that depending on family income, families with children enrolled in CHIP are only responsible for 0-2 percent of their child’s medical expenses compared to the exchange plans that would require families to pay anywhere from 5-35 percent of the cost.  Moving these children into the exchange would leave many low-income children worse off – paying more for fewer benefits.

The Director of the Congressional Budget Office (CBO), Doug Elmendorf, confirmed these findings in a blog post over the weekend.  Director Elmendorf asserts that by keeping children in CHIP rather than moving them into the exchange, the number of uninsured children would actually be reduced! Like the House bill does, the Senate Finance Committee’s original mark would have terminated the CHIP program when it was up for reauthorization in 2013 and moved children in CHIP into an untested health insurance exchange.  However, Senator Rockefeller’s amendment to maintain the CHIP program until 2019 passed with bipartisan support in Committee, potentially affecting 14 million children who are expected to be enrolled in 2013.

October 13, 2009

The Senate Finance Committee has just approved the America’s Healthy Futures Act of 2009 and it is now in the process of being merged with the Senate Health, Education, Labor and Pensions Committee's bill for consideration by the full Senate. Thanks to the leadership of Senator John D. Rockefeller (D-WV) the Senate Finance Committee bill keeps the Children's Health Insurance Program (CHIP) intact, rather than ending it and moving children to an unproven health "Exchange."  However, the bill still does not ensure all children the comprehensive, affordable and simple coverage they need to survive and thrive.

Health care reform is complicated, but ensuring that children can get and keep the health and mental health care they need to grow up healthy is not. Three elements must be included in any final health care reform bill to ensure that all eligible children can easily enroll in affordable coverage and get the comprehensive care they need.  Until child health coverage in the Exchange can be guaranteed to provide children with benefits and cost-sharing protections as good as or preferably better than they have today, we must keep CHIP and also make it better:

Coverage must be affordable. All children up to 300 percent of the federal poverty level (about $66,000 for a family of four) must be made eligible for CHIP so they can benefit from its cost sharing protections.

  • The CHIP program is projected to cover more than 14 million children by 2013. Children who are able to enroll in CHIP and keep CHIP coverage will maintain the benefits and cost sharing protections they have now. However, health care reform is our opportunity not just to maintain the status quo, but to improve access to care for children. CHIP must be made mandatory and funded so that all eligible children will be covered. Under the Senate Finance Committee bill, when the CHIP money runs out for a state, children will be eligible for a tax credit for the Exchange, but will not be guaranteed the same benefits at the same price they would have gotten through CHIP. States also must receive new federal funds to create a national eligibility floor in CHIP of 300 percent of poverty and then guarantee coverage for all eligible children.

Benefits must be comprehensive. Real child health reform must guarantee all children access to the health and mental health services they need to maximize their health and development.

  • Under the Senate Finance Committee bill, a million children will be newly eligible for Medicaid, where they will be entitled to receive the regular and periodic screenings and assessments and the full range of health and mental health services and treatment they need. Children who are in CHIP programs with comparable benefits will not lose them. That's good news. However, there are millions of children in CHIP who don't yet get the same comprehensive benefits they need to survive and thrive. Most children in the Exchange are eligible for some basic benefits, but would be denied the full range of benefits they can get in Medicaid or CHIP.

The health system must be simple and seamless. A streamlined application and enrollment process is critical to make it easy for children to get and stay enrolled. State bureaucratic barriers now keep about two-thirds of the more than eight million uninsured children who are eligible for CHIP or Medicaid from getting health coverage.

  • Thanks to an amendment offered by Senator Jeff Bingaman (D-NM), the Senate Finance Committee bill now requires states to adopt a "no wrong door" policy to streamline enrollment processes to determine eligibility for Medicaid, CHIP and tax credits—a sort of one-stop shopping. This will prevent the multiple subsidy programs from creating pointless red-tape for families, high administrative costs and erroneous eligibility decisions, resulting in reduced program participation. However, the bill still does not require states to implement many other simplification measures, such as 12-month continuous eligibility, presumptive eligibility upon request for medical services, or automatic renewal, which have proven successful in enrolling eligible children in Medicaid and CHIP. Unless states are required to eliminate barriers to enrollment and recertification, health reform will be a hollow promise for millions of children who will remain uninsured even though they are eligible for coverage.

October 6, 2009

Today, members of the Congressional Black Caucus sent a letter to Speaker of the House Nancy Pelosi expressing their committment to ensuring all children are better off—not worse off—after health reform than they are now.

October 2, 2009

Senator Rockefeller

Last night, two amendments passed the Senate Finance Committee that serve as important steps forward to ensure all children will be better off after health reform, but more action is needed to ensure that all children have affordable, comprehensive, simple health coverage.  Senator Rockefeller (D-WV), a longtime champion for children, offered an amendment approved with bi-partisan support that would extend the Children's Health Insurance Program (CHIP) program through 2019, so the coverage gains achieved through CHIP reauthorization will not be lost in health care reform. By 2013, CHIP is projected to cover more than 14 million children.  Under this amendment, children will be able to keep their CHIP coverage and not be forced to enroll in the untested and unknown Health Insurance Exchange where benefits are expected to be worse, while cost-sharing could be 10-20 times higher. View a video of the discussion of this amendment and the vote. 

Also accepted last night was an amendment offered by Senator Bingaman (D-NM) which would provide a “No Wrong Door” policy to streamline enrollment processes to determine eligibility for Medicaid, tax credits and CHIP—a sort of one-stop-shopping. For example, a mother with two children could have one child eligible for CHIP and another child eligible for Medicaid, and she herself might only be eligible for tax credits. Under this amendment, this mother could fill out one application in one place for all of the family members to enroll in each of the different programs.  This is intended to prevent multiple subsidy programs from creating pointless red-tape for families, high administrative costs for government, erroneous eligibility decisions and reduced program participation.

While both of these amendments are critical steps forward for children, much work still lies ahead in the coming weeks as we work to build on the success of CHIP and strengthen the program to make certain that children are better off—not worse off—under health reform, with coverage that is affordable, comprehensive and simple to get and keep.

September 2009 Legislative Update

September 29, 2009

The Senate Finance Committee has resumed its markup of Chairman Baucus’ proposal for health reform and this week we expect the Committee to vote on a number of amendments that would improve the Committee’s bill for children.  Most notable is Senator Jay Rockefeller’s (D-WV) CHIP Amendment. The Rockefeller Amendment (#202) would improve the successful Children’s Health Insurance Program (CHIP) and extend it until 2019.  It would help eliminate the lottery of geography by requiring all states to cover children up to 300% of poverty in CHIP by 2013.  Senator Rockefeller’s Amendment will also simplify the process by which children get enrolled and stay enrolled in CHIP and Medicaid.  This amendment is a critical step forward to ensuring real child health reform that leaves children better – not worse – off than they are now.

Since Chairman Baucus released his proposal on September 16, several amendments have been added that would improve coverage for children and low income families.  The Committee has voted to accept several children’s amendments. They include: Senator Menendez’s amendment to allow children to qualify for child-only health insurance plans in the exchange when their parents may not be eligible; and Senator Stabenow’s amendment to ensure that states can cover therapeutic foster care for children in out-of-home placements.

Momentum is building, but much work still lies ahead. Any final health reform bill must make it simple for more children to enroll in affordable, head-to-toe health coverage. We must guarantee real child health reform for all children this year!

September 16, 2009

How Senate Finance Committee Chairman Max Baucus’ Proposal Could Leave Millions of Children Worse Off

On September 16, 2009, Senate Finance Committee Chairman Max Baucus (D-MT) released his "Chairman’s Mark of America’s Healthy Future Act of 2009"—a proposal which will be considered by the Committee. While the Chairman’s Mark will expand and improve coverage to some children, the proposal does not ensure the comprehensive, affordable and simple coverage that all children need. Millions of children could be left worse off after health reform than they are now, facing higher costs for fewer benefits.

Health care reform is complicated, but ensuring that children can get and keep the health and mental health care they need to grow up healthy is not. Three provisions must be added to the proposal that would allow eligible children to easily enroll in affordable coverage and get the comprehensive care they need: 

1. The health system must be simple and seamless. A streamlined application and enrollment process is critical to make it easy for children to get and stay enrolled. State bureaucratic barriers now keep about two-thirds of the more than 8 million uninsured children who are eligible for CHIP or Medicaid from getting covered.

The Chairman’s proposal misses the mark for children.

  • None of the simplification measures, such as 12-month continuous eligibility, presumptive eligibility upon request for medical services, joint verification for eligibility with other federal programs, or automatic renewal, which have proven to be successful in enrolling eligible children in Medicaid and CHIP, are included. Unless states are required to eliminate barriers to enrollment and recertification, millions of children will remain uninsured after health reform, making it a hollow promise.

2. Benefits must be comprehensive. Real child health reform must guarantee all children access to all the health and mental health services they need to maximize their health and development.

The Chairman’s proposal misses the mark for children.

  • The proposal recognizes the value of assuring children receive comprehensive health and mental health care as children in Medicaid do today, but it does not require these benefits for all children in the exchanges. The importance of guaranteeing children of all ages regular and periodic screenings and assessments at various intervals and the full range of health and mental health services and treatment they need is well known.

    Under the Chairman’s proposal, the CHIP program would end in 2013, at which time all enrolled children would be moved to health insurance exchanges.  Since then, this provision has been amended to make moving children to the exchanges contingent upon certification that coverage offered in the exchanges is at least comprable to The proposal contains a provision that would give all children in families with incomes below 250 percent of poverty ($55,125 a year for a family of four) who have health coverage through exchanges comprehensive benefits through an additional health insurance package provided by the state, known as an "EPSDT wrap around." However, this complicated "wrap around" mechanism has not been shown to truly get eligible children the services they need, and could prove to be a new bureaucratic barrier and hollow promise. Additionally, children in families enrolled in the exchanges with incomes above 250 percent of poverty who have been receiving the EPSDT benefit package in CHIP will not be eligible for the same benefits or cost-sharing they have today. Twenty-two states now cover children at 250 percent of poverty or higher under CHIP. This means that in at least 22 states, children could be worse off under health reform than they are now

3. Coverage must be affordable. All children up to 300 percent of the federal poverty level (about $66,000 for a family of four) need cost sharing protections consistent with current out-of-pocket limits in Medicaid.

The Chairman’s proposal misses the mark for children.

  • Children in families up to 250% of poverty will receive the cost sharing protections consistent with current out-of-pocket limits in Medicaid when they are moved into the exchanges.  This provision is critical, but it does not go far enough: children in families with incomes above 250 percent of poverty will likely pay far more for premiums and cost sharing for services under the Chairman’s proposal than they do today, even if their incomes are below 300 percent of poverty and they qualify for subsidies.  This means lower income families will be paying for more, but will get less under heath reform unless the CHIP income protections are extended.

August 2009 Legislative Update

With Congress wrapping up their August recess work back home, health reform continues to take shape in a way that could make millions of children worse – rather than better – off at the same time insurance companies and drug companies will profit.  Millions of children could face higher costs for fewer benefits. For children to be better off, changes are needed to make it simple for them to enroll in comprehensive and affordable health coverage.  Amendments and agreements supported by Representatives Bobby Scott (VA) and Bobby Rush (IL) will do that. They worked hard to do the right thing for children and we need to ensure it continues.

Resource: Side-by-side summary from Georgetown's Center on Children and Families on how children fare in the proposals.

Amendments and Agreements to Make Health Coverage for Children Affordable, Comprehensive and Simple

Amendment to H.R. 3200 Proposed by Rep. Bobby Scott (Approved by the Committee on Education and Labor):

Comprehensive Benefits – It guarantees the right to all medically necessary health and mental health care for all children who receive coverage through the new health Exchange.  The amendment only addresses children in the Exchange because the Education and Labor Committee does not have jurisdiction over the Children’s Health Insurance Program (CHIP).

Amendments to H.R. 3200 Proposed by Rep. Bobby Rush (Discussed in colloquy with Energy and Commerce Committee Chairman Henry Waxman and withdrawn):

Comprehensive Benefits – These amendments would ensure that all children in CHIP now (and in CHIP until it expires in 2013 or at a later time) will benefit from the same right to all medically necessary health and mental health care that children receive under Medicaid.  They also would provide comprehensive health and mental health care for all children in the Exchange in families up to 300 percent of the federal poverty line. Some states already provide these comprehensive benefits to children in CHIP.

Simplification – By October 1, 2013, all states must have in place each of the following simplification measures (which states are now eligible for federal incentives to do under CHIP):

  • 12-month continuous eligibility
  • “Express lane” eligibility process
  • Presumptive eligibility upon request for medical services
  • By mail, phone or online verification of income
  • Joint verification for CHIP eligibility with other federal programs (such as food stamps)
  • Automatic renewal

In addition, the eligibility, enrollment and recertification process for children in public coverage may be no more difficult than the process for children covered under the new health insurance Exchange described in H.R. 3200.

Affordability and Cost-Sharing – This amendment would help ensure that children will not be worse off under health reform than they are today.  In 2013, millions of children could be moved from CHIP into the Exchange, where they could be subject to higher cost sharing limits than under CHIP.  These protections will guarantee cost-sharing that is no higher than what children pay now in Medicaid.