Sinking SCHIP

( – promoted by EaBo Clipper)

Our neighbors over at BMG think its newsworthy that congressional Republicans are bashing Bush over his threated veto of the SCHIP reauthorization. The SCHIP authorization bills are windfalls for the states! I’m surprised so many have had the courage to say “NO”.

What do I mean by windfall? Over the first 10 years of SCHIP, federal expenditures grew by about 1.5% annually. In the House version of the bill, there is no cap. Could be less. Yeah, right. 


H§101. Establishment of new base CHIP allotments. Appropriations for FY2008 onward would be provided without a national amount specified. The annual appropriation would be determined automatically as the sum total of the allotments calculated for all the states and territories. No end year would be specified; the program could receive annual appropriations in perpetuity.

The Senate version sets a cap. BUT, the annual growth rate is a whopping 16.5% a year! That’s on top of a near doubling of the initial cap in its first year (from $5B to over $9B).

As for the FPL limits, for the 15 states that administer SCHIP as a standalone program (as opposed to as a Medicaid expansion):

A state is free to establish its own eligibility rules, taking into account age, geography, residency, disability status, and access to other coverage

Additionally, by using existing flexibility to define what “counts” as income, any state can raise its effective SCHIP income eligibility level above 200% FPL through the use of income disregards. The Senate version has a provision that would limit matching rates when income is above 300% without taking into account some of the disregards. But, in reality, it’s up to states to determine income eligibility, and without any oversight, these limits are pretty much meaningless.

SCHIP has already been used to cover adults, to cover children who already had private health insurance, and there have been no quality or eligibility audits. That’s one good thing that I see in the reauthorization proposals — some call for proof that the federal dollars are being used well.  The current data is sketchy. For example, estimates of the percentage of SCHIP beneficiaries who were already privately insured ranged from 5-17%. I want to make sure any increase is actually getting to its intended target. It would be better to get the metrics before ramping up such a huge increase.

As I said in an earlier BMG comment, it appears that 1/3 of MA’s public health spending is going to something other than providing insurance. Let’s fix that before we before we double the amount of tax dollars going into this program.

I’m no fan of Bush, but he’s right on this one.

As for Ogonowski’s statements about benefits going to illegal aliens, currently illegal aliens are eligible only for emergencies. Or, in the case of SCHIP stand alone programs, only pregnancy-related issues are covered. The House version does include wording to state specifically that no federal dollars are to be used for illegal aliens (the Senate version is silent on the topic).

However, given the lax oversight of this program, I’m not holding my breath that this would be enforced. In fact, the House version includes wording that would make it easier to be deemed eligible. For example, states could rely on the same agencies who determine eligibility for food stamps, free and reduced lunches, or state-subsidized child care to make determinations of who is eligible for SCHIP. Right. I wonder how that will turn out.

This is just one more reason I support Jim Ogonowski. He’s done his research, and he actually thinks for himself. He doesn’t simply tow the party line, and he’s not afraid to speak the truth. I mean, let’s be honest, his opponents are going to try to make it seem like he doesn’t care about poor children.

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