Dollar for dollar, providing better health care for children represents one of the best returns on investment available in the U.S. This involves not only better monitoring of quality and making quality improvements, but also enrolling eligible children in health programs such as SCHIP and Medicaid. And it means ensuring that health care systems – including safety net providers and health insurers – are responsive to the unique health needs of children.
By some estimates, almost three-fourths of America’s nine million uninsured children are eligible for either State Children’s Health Insurance Program (SCHIP) or Medicaid. As Congress begins debating the reauthorization of the program in earnest, policymakers are examining what is keeping these children from enrolling.
Authorization for SCHIP expires this September, and, in the coming months, Congress will be debating the program’s extension. Established in 1997 with an authorized 10-year funding level of $40 billion, SCHIP’s accomplishments in providing coverage to an estimated six million children are now widely acknowledged. SCHIP pursues its relatively simple goal – broader coverage for low- and moderate-income children – through a relatively complicated structure. So before key decisions can be made about the program’s future, it is important to have a baseline understanding of what makes the program work.
Suddenly, Capitol Hill is talking about health issues again. Incoming House Speaker Nancy Pelosi promises that Democrats will roll back the prohibition against the federal government negotiating drug prices on behalf of Medicare beneficiaries. (A Kaiser Family Foundation poll released today found broad bipartisan support for this idea.) Incoming Senate Majority Leader Harry Reid says one of his three top priorities will be more funding for stem cell research. Others want to revisit the importation of prescription drugs from Canada. Additionally, the 110th Congress will consider whether to continue the State Children’s Health Insurance Program in its present form.
Come January, we can expect to see some new approaches to health legislation. Sen. Harry Reid, incoming Senate majority leader, says one of his top three priorities will be more funding for stem cell research. House Speaker-to-be Nancy Pelosi wants a vote early on to roll back the prohibition against the federal government negotiating prescription drug prices for Medicare beneficiaries. And these are just two of the health issues likely to be debated in the new Congress. The White House too will have a definite voice in the debates to come.
The growing complexity of our health care system, and time demands on providers, can cause patients’ non-obvious needs to get lost in the shuffle. Sometimes, the result can be less-than-optimal care. In response, providers are trying to be more responsive to patients’ cultural traditions, family situations, personal preferences and values. Some have tagged this movement “patient-centered care.”
The Long-Term Care Partnership Program allows purchasers of private long-term care insurance to qualify eventually for Medicaid coverage of long-term care services without having to meet the same asset requirements as other Medicaid applicants. Partnership programs began in 1987 in four states – New York, California, Connecticut, and Indiana.
The Census Bureau’s recently released figure on the number of uninsured in 2005 is 46.6 million, an increase of 1.3 million people over 2004. Two new studies by John Holahan and Bowen Garrett of the Urban Institute offer in-depth analyses of the economic and demographic factors that underlie this troubling statistic.
One byproduct of the patchwork system of public and private health insurance coverage in the United States is that individuals can gain or lose health insurance as they gain or lose jobs, or gain or lose eligibility for public programs. This phenomenon, known as “churning,” can lead to gaps in health insurance coverage and unnecessary administrative costs for state governments that have to process the same individuals repeatedly.
As health care tabs rise, every American feels the impact – on personal finances, company budgets, state coffers and federal entitlement programs. Rising demands for services from an aging population, medical advances, and quality imperatives all impact health care costs. Within this context, it is important to understand how various sectors of our health care system price services and account for costs.
With New Orleans largely evacuated and hundreds of thousands of people separated from their regular health care providers, how will Hurricane Katrina’s evacuees attend to their health and health care needs?
The National Governors’ Association recently made a series of recommendations that would give states more flexibility in administering Medicaid benefits. In addition, the Medicaid Commission has been tasked with the short-term objective of developing policy options to achieve program savings, and Congress will soon consider changes to Medicaid that could include modifications to Medicaid’s benefits as well.
With rapidly rising health care costs and pressures on both federal and state budgets as a backdrop, lawmakers are considering a variety of changes to Medicaid this year. This briefing will offer a chance to learn more about the fundamentals of Medicaid, for those who would like to brush up on their knowledge as well as those new to the subject.
Millions of children are eligible for Medicaid and the State Children’s Health Insurance Program (SCHIP), but remain without coverage. How have state budget constraints affected outreach and enrollment in Medicaid and SCHIP? What are the goals of the Administration’s proposed “Cover the Kids” campaign?
President Bush’s FY 2006 budget could have long-lasting effects on several health programs. If enacted as is, the budget would trim $60 billion in the growth in Medicaid spending over the next 10 years. At the same time, the budget offers $11 billion in new money to enroll children in Medicaid and the State Children’s Health Insurance Program. It would provide $74 billion in tax incentives to help the uninsured buy coverage. Some congressional budget leaders have signaled their intention to find budget savings in another entitlement program – Medicare.
The budget season is upon us. The Congressional Budget Office’s January 2005 “Budget and Economic Outlook” provides an overview of where Congress will start, and the President’s budget request will arrive next week. The journey down the sometimes bumpy, sometimes difficult-to-understand road to a federal budget for FY 2006 is beginning.
The 2004 election featured debates on major health issues including costs, access, and affordable prescription drugs. These issues will likely be subjects of continued focus during the upcoming Congress.
Despite vigorous efforts in recent years to insure more uninsured children, the number of kids without coverage is stuck at 8.4 million. Public coverage of children is on the rise – up 1.7 million between 2002 and 2003. But employer-sponsored coverage is shrinking – down 1.2 million during the same period. One reason: Firms are subsidizing coverage for individual employees to meet insurers’ minimum participation requirements, but aren’t as likely to subsidize family coverage.
In August 2004, the U.S. Census released its most recent figures, showing that the number of Americans without health insurance increased to 45.0 million in 2003, up from 43.6 million people in 2002. Those covered by government health insurance programs increased between 2002 and 2003 — from 73.6 million to 76.8 million, largely as a result of greater coverage by Medicaid. At the same time, employer-based coverage shrank. The number of people covered by employment-based insurance fell from 175.3 million to 174.0 million from 2002 to 2003, and the share of the population covered declined from 61.3 percent to 60.4 percent.
For decades, it was routine in the U.S. to house individuals with disabilities in institutions. Those with mental illnesses, for instance, were placed in “insane asylums,” as they were once called. The U.S. Supreme Court took a firm step toward ending this practice five years ago. In the Olmstead v. L.C. decision, the court found that institutional isolation of individuals with disabilities was, under certain circumstances, a violation of the Americans with Disabilities Act.
Low-income Medicare beneficiaries are a vulnerable population because of their disproportionately high medical and long-term care needs. Among low-income beneficiaries are nearly seven million individuals who are considered “dual-eligibles,” with coverage from both Medicare and Medicaid. They represent around one in six Medicare beneficiaries and one in seven Medicaid beneficiaries.
Despite significant state and federal efforts to cover kids, including the State Children’s Health Insurance Program, 9.2 million Americans under the age of 19 (12.1 percent of all Americans) went without health insurance in 2001, according to the U.S. Census Bureau. Such a lack of coverage can have serious clinical and financial consequences for children and their parents, such as children not receiving critical preventative care, including immunizations. At the same time, even children with coverage don’t necessarily receive high quality care. To cite one example, immunization rates for children two or younger in 2000 were below the Childhood Immunization Initiative’s goal of at least 90 percent.
Dual eligibles are low-income Medicare beneficiaries who are also eligible for Medicaid. They are a vulnerable population because of their disproportionately high medical and long-term care needs. At any given time, nearly seven million individuals are considered dual eligibles, representing around one in six Medicare beneficiaries and one in seven Medicaid beneficiaries.
Incremental improvements in coverage have been the focus at both national and state levels for several years. But there are indications that lack of coverage is growing, and broader proposals, aimed at securing coverage for a large number of the uninsured, are beginning to get more attention—tax credits, employer or individual mandates, public program expansions, and various combinations. The plans differ widely in scope, cost and impact, but any of them would mean major change in the status quo.
Although less well known than Medicare, Medicaid covers even more people. In fact, about 47 million people were expected to have been covered by the program for at least part of last year, including more than one in four children across the country. Medicaid, which is financed by both states and the federal government, also pays for nearly half of all long-term care services.
In November 2002, the Centers for Medicare and Medicaid Services (CMS) launched a nationwide initiative to improve nursing home quality by making information about the quality of care in individual nursing homes much more widely available. This was a welcome step toward giving consumers more information about the quality of nursing home care. Since a study by the Institute of Medicine more than 15 years ago found serious and widespread deficiencies in nursing home care, several major studies have confirmed continuing difficulties.