Getting aboard SCHIP

Getting the money to enroll children in SCHIP is important -- and so is making sure that every child who is eligible gets coverage.

The State Children's Health Insurance Program, a federal and state effort that provides health coverage to more than 6 million children, is due to expire on Sept. 30. Congress and President Bush both favor extending the life of the 10-year-old program, even if right now they can't agree on what the income threshold should be on who should be covered and whether the 600,000 adults in SCHIP can stay in it. (AMA delegates also are slated to discuss SCHIP at their Annual Meeting, which starts after we go to press.)

Eventually there will be an agreement defining who is eligible under SCHIP. Then, as is now the case, it's important to make sure that all of those who are defined as eligible get covered.

For all the success in SCHIP in covering low-income children -- and some adults -- who are not Medicaid-eligible, more than 2 million uninsured children currently eligible for the program are not enrolled. It is time to fix the process in SCHIP enrollment. Congress must also provide the funding to make sure all those enrolled get coverage.

Applying for SCHIP can be confusing for families, but there is help. They can call a Dept. of Human Health Services toll-free phone number -- 877-KIDS-NOW -- or go to a Web site (link) that will refer them to whichever agency in their home state arranges coverage. Once families take that step, they have to find out if they're eligible for coverage.

SCHIP originally was proposed to cover children whose family income is up to 200% of the federal poverty level, but families earning more than that might not know they're eligible. As HHS points out, within federal guidelines, "each state determines the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures." New Jersey allows children whose family income is up to 400% of the poverty level to enroll, and other states have allowed adults to enroll as well.

With all the confusion over who might be eligible, and the difficulties of the application process, more feasible solutions are necessary to get more kids covered. One solution would be to reach out to families already participating in other state and federal relief programs.

For example, the Health Care Coverage Coalition for the Uninsured, a coalition of the largest physician, hospital, business, insurance, pharmaceutical and consumer organizations, including the AMA, has proposed that states be given the flexibility to deem uninsured children from low-income families eligible for and to enroll them in Medicaid or SCHIP when they qualify for other means-tested programs such as food stamps.

Also, for years the AMA has made it policy to encourage states to maximize their efforts to enroll children in SCHIP, and to encourage state and county medical societies to push states to make that effort.

The question that follows, though, is how to pay for such coverage. Senate and House resolutions, as of this writing, propose a total of $50 billion spent over the next five years, while President Bush is suggesting $30 billion over the same period. That would limit the matching funds for SCHIP enrollees above 200% of the federal poverty line to 50%, similar to Medicaid. (In many cases, the match is higher, up to 76%.)

The AMA has not taken a formal position on any resolution. But the Association, along with 66 other medical associations, hospital organizations, consumer groups and insurers, on May 22 sent a letter to Congress suggesting that increasing the cigarette tax by 61 cents per pack would go a long way toward funding Congress' proposal. That would bring the cigarette tax up to $1 per pack -- which also would have the benefit of reducing smoking, given how numerous studies show the costlier cigarettes become, the less likely children are to smoke.

America's children are the future, and one of the best ways to ensure the future is to insure their health care now. Making sure that the maximum number of children are covered will take money, but just as important, it also will take education so their families know health coverage is available.