Government

HHS gives lower estimate of uninsured children eligible for SCHIP

Democratic senators criticized the analysis as flawed. Meanwhile, public support for a cigarette tax for children's health is strong.

By Doug Trapp — Posted July 9, 2007

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Fewer uninsured children are eligible for the State Children's Health Insurance Program than previously estimated, says a new Health & Human Services analysis released last month.

Between 689,000 and 794,000 uninsured children are eligible for SCHIP but not enrolled in the program, according to the study, conducted by the Income and Benefits Policy Center of the Urban Institute, a nonpartisan policy analysis organization.

In contrast, many widely reported calculations, including reports by other Urban Institute staff, conclude that there are 1.7 million to 2 million children who qualify for the program but lack any coverage. This is out of a nationwide total of about 9 million uninsured youngsters. SCHIP covers about 6 million children.

The HHS analysis said larger estimates are due to undercounting the number of people covered by Medicaid and SCHIP in Census Bureau surveys. But Sens. John D. Rockefeller (D, W.Va.) and Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee, criticized the new estimate as politically motivated and questioned the methodology.

"The study flies in the face of all accepted data on the number of uninsured American children who desperately need and could receive health coverage through a renewal of the SCHIP program," Baucus said.

The HHS report concluded that 689,000 SCHIP-eligible uninsured children are at or below 200% of the federal poverty level. President Bush's budget proposal calls for limiting enhanced federal matching funds for SCHIP to enrollees at or below 200% of the poverty level.

The report also estimates that 794,000 uninsured children are eligible under the varying state SCHIP eligibility limits. As of May, 18 states cover children in families earning more than 200% of the poverty level, according to the Center for Children and Families at Georgetown University's Health Policy Institute.

Baucus said the calculation is flawed because it counts as uninsured only those who lacked insurance for an entire year. But SCHIP or Medicaid don't require applicants to be uninsured that long to be eligible for coverage, he noted.

Linda Giannarelli, an Urban Institute senior research associate and one of the analysis' co-authors, said HHS specified that parameter and that the study had been conducted as part of an ongoing contract the Urban Institute has had with the department for 30 years. Higher estimates of SCHIP-eligible uninsured children may capture those lacking coverage at any one time, which is naturally a larger number, she said. HHS officials did not return calls for comment.

Baucus has been working with other senators for about a month to craft an SCHIP reauthorization bill but had not finished it as of press time. The program expires Sept. 30, the end of fiscal 2007.

Public backs cigarette tax

Meanwhile, Congress' 2008 budget road map includes a 61-cent federal cigarette tax increase to help pay for SCHIP expansion. A new poll indicates widespread public support for an even larger cigarette tax hike.

A majority of likely voters across all demographic groups support increasing the federal cigarette tax by 75 cents for health care coverage for uninsured children, according to a telephone poll of 1,000 likely voters in late May and early June conducted for the Campaign For Tobacco-Free Kids. The support ranges from as low as 61% among independent voters to 74% among people earning between $50,000 and $80,000 a year.

A federal cigarette tax increase to support health care is overdue, said incoming American Medical Association President Ronald Davis, MD. The tax stands at 39 cents.

"It's been 10 years since Congress last voted to raise the federal cigarette tax," Dr. Davis said. "With what we know now about the dangers of smoking and the benefits of raising the price of cigarettes, it's unconscionable that action has not been taken to raise the tobacco tax and protect the health of Americans."

The AMA along with 66 other medical associations, hospital organizations, consumer groups and insurers signed a letter in May supporting a 61-cent cigarette tax increase, which would raise at least $35 billion over five years. The AMA, as a member of the Health Coverage Coalition for the Uninsured, supports full funding of SCHIP to cover all eligible children and refundable, advanceable tax credits for buying health insurance.

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ADDITIONAL INFORMATION

Cigarette tax for SCHIP

A telephone survey of 1,000 likely voters, conducted for the Campaign for Tobacco-Free Kids from May 29 to June 3, found a majority of major demographic groups support a 75-cent federal cigarette tax increase to expand health care for uninsured children. The existing tax is 39 cents.

Support Oppose
Men 66% 30%
Women 68% 26%
Democrat 72% 25%
Republican 67% 27%
Independent 61% 34%
18-39 years old 71% 26%
40-59 years old 67% 29%
60 or older 63% 29%
White 68% 27%
Black 67% 31%
Hispanic 69% 29%
Less than $30,000 62% 32%
$30,000 to $50,000 67% 32%
$50,000 to $80,000 74% 24%
$80,000 or more 69% 23%

Note: Remaining percentages of respondents replied "don't know."

Source: Mellman Group, June

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External links

Dept. Health & Human Services analysis of State Children's Health Insurance Program eligibility (link)

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