The calendar and the newly cold weather say January, but the efflorescence of health care reform proposals indicate that it is springtime in Washington. As the new Congress gears up to tackle specific parts of the government’s health care portfolio — for instance, Medicare Part D and reauthorization of SCHIP — newly invigorated proposals to transform access to insurance are also being heard. Just this week two new proposals on the federal level have been made. On January 10, Senator Edward M. Kennedy (D-MA), at the Senate Health, Education, Labor, and Pensions Committee hearings, proposed a Medicare-for-all program based on the federal employees’ health insurance programs. On January 11, Jacob Hacker, a political scientist from Yale, active in Democratic circles, unveiled a proposal at the Economic Policy Institute that would combine Medicare expansion while maintaining employer coverage for large companies in a play-or-pay proposal. Hacker also testified the day before at the hearings convened by Senator Kennedy.
These new proposals from the federal government side come on the heels of Massachusetts’ health care reforms to extend coverage to all its residents and Governor Schwarzenegger’s proposals for California made earlier this week. They also follow calls for extending coverage to all children in New York made by Governor Spitzer and state expansions to cover kids in Illinois and Pennsylvania.
Can state reforms lead to universal coverage? While the Massachusetts reforms and California’s proposals have elicited both interest and praise, many health care activists on the federal level also view them with skepticism. Judy Feder, dean of Georgetown University’s Public Policy Institute and a discussant at the EPI’s event, doubted that health reform initiatives from the states could lead to universal coverage. Hacker and Feder both viewed health insurance as social insurance with a guaranteed benefit, which should be defined by the federal government, and noted the economies of scale that the federal government could bring to bear on costs.
As the 110th Congress goes forth, it will be interesting to see how many of the newly flowering proposals get planted and bloom. How will the new Congress — particularly the new Democratic majority — balance federal proposals versus state initiatives? How will Congress balance calls for universal childhood coverage first and SCHIP reauthorization, versus the calls for universal coverage for all now? The pay-as-you-go rules have the potential to block almost all health care reforms and expansions under current budgetary constraints.
Enrolling kids in Medicaid. The children’s advocacy community also has to confront the potentially devastating impact of the CMS’s interpretation of the Deficit Reduction Act of 2005 regulation for citizenship documentation. Effective July 1, 2006, the CMS ruled that the DRA’s requirement that citizens bring proof of citizenship to enroll in Medicaid meant that citizens had to provide original or certified documents of citizenship. For children, this means providing original or certified birth certificates, a costly and not always easy feat for low-income families. It also means that families cannot enroll their children over the phone of through the Web, undoing many of the streamlined application procedures developed in the past decade.
Cindi Jones, chief deputy director of Virginia’s Department of Medical Assistance Services (Medicaid), noted at a Kaiser Family Foundation Press briefing on January 9 a decline of approximately 12,000 children in Virginia’s enrollment since July 2006, when the regulations were put in place. Other states, like Kansas, are also experiencing declines in enrollment or renewal. Obstacles and declines in Medicaid enrollment have the potential to undo many of the gains made in SCHIP, because the two programs often share enrollment procedures in a state. Advocates for children will also have to confront the advocates for universal coverage for all over the design and benefit packages proposed. Not all the proposals for universal coverage maintain an ideal package of benefits for children.
Stay tuned, as Health Affairs releases its theme issue on children’s health and well-being in early March 2007. It will be an interesting year.