1. Genevieve Kenney The Urban Institute National Health Policy Conference February 12, 2007 The Employer-based Health Care System - Shifting Responsibilities: SCHIP at Reauthorization

2. 2 Background on the State Children’s Health Insurance Program  SCHIP is up for reauthorization in 2007  SCHIP was created in August 1997 to address coverage gaps among low-income uninsured children not eligible for Medicaid  SCHIP is a block grant with a higher federal match rate than under Medicaid  Anti-crowd out provisions were included in the statute; no wrap-around benefits, option of creating premium assistance programs  States had flexibility over their program structures, eligibility, benefits, cost sharing, crowd-out prevention, and enrollment limits

3. 3 Share without Health Insurance Coverage at the Time of Interview, by Age Group: 1997-2003 Source: JS Schiller, M Martinez, P Barnes. Early release of selected estimates based on data from the 2005 National Health Interview Survey. National Center for Health Statistics. http://www.cdc.gov/nchs/nhis.htm. June 2006. Children Adults

4. Changes in Health Insurance Coverage of Low-Income Adults and Children, 2000 to 2004 4 AdultsKids ESI AdultsKids Medicaid/SCHIP AdultsKids Uninsured Source: S Zuckerman and A Cook. “The Role of Medicaid and SCHIP as an Insurance Safety Net.” Washington, DC: The Urban Institute. August 2006.

5. 5 Most SCHIP Enrollees Do Not Have Access to ESI Source: Kenney and Cook, 2007Source: G Kenney and A Cook. “Coverage Patterns Among SCHIP-Eligible Children and Their Parents.” Health Policy Online No. 15. Washington, DC: The Urban Institute. February 2007.

6. 6 Insurance Coverage among Children Who Qualify for SCHIP Based on Income Source: G Kenney and A Cook. “Coverage Patterns Among SCHIP-Eligible Children and Their Parents.” Health Policy Online No. 15. Washington, DC: The Urban Institute. February 2007.

7. 7 Source: Congressional Research Service (CRS) analysis and CRS SCHIP Projection Model * Projected Spending Level Gap Between Available Federal Funds and Spending Has Been Growing * SCHIP Allotment SCHIP Spending

8. 8 Looming Federal Funding Shortfalls  Funding problems are more acute in some states than in others; a growing number of states are projected to face shortfalls in the coming years and funding uncertainties may limit state expansions (Peterson 2006)  Despite $4 billion accumulated in unspent funds, a number of states will face federal funding shortfalls by May 2007, and Georgia is slated to face a shortfall even earlier  CBO baseline includes an annual federal funding level of $5.0 billion. At that funding level, SCHIP enrollment is projected to fall from 4.4 to 3.1 million over five years (HHS 2006)  An estimated $12.7 to $14.6 billion in additional funds would be needed to maintain programs at current levels through 2012; even more is needed to cover remaining eligible uninsured children or other groups (e.g. low- income parents), but would require offsetting savings elsewhere in the budget (Broaddus and Park 2006; Peterson 2006)

9. 9 SCHIP at Reauthorization  Federal budget situation  State efforts to reach universal coverage  Federal health care reform proposals to address issues with employer-based coverage