The House Ways and Means Committee and the House Energy and Commerce Committee majorities yesterday released their mark-up reauthorizing the State Children’s Health Insurance Program. The House bill, known as the CHAMP act, differs significantly from the Senate Finance Committee’s bill in scope, but both bills reject estimates from the Department of Health and Human Services of the number of uninsured children. 

On June 18th, HHS released a study, done by a component of the Urban Institute and using the Transfer Income Model (TRIM) methodology that reduced the numbers of children potentially eligible for Medicaid and SCHIP to 1.1 million, a much lower number than the commonly accepted estimates in the 5-6 million range. These numbers elicited a great deal of skepticism on Capitol Hill, with critics charging the department with deliberately skewing the numbers for political gain.

The CBO on July 24th weighed in on the controversy in favor of the older research. It found that the Current Population Survey (CPS) run by the Census Bureau, and even more so the Medical Expenditure Panel Survey (MEPS) conducted by the Agency for Healthcare Research and Quality, yield numbers of children eligible for coverage much higher than those reported by HHS. The MEPS and HHS estimates differ most in their estimates of the number of children who are potentially eligible for a whole year but are not covered for that whole year. The MEPS estimate for this group is 2.7 million children, versus HHS’ estimate of 1.1 million.

Over the summer, Health Affairs will publish a series of papers on the current SCHIP program and proposals for reauthorization. Several of our future papers will discuss estimates of eligible children using the MEPS, the CPS, and the Survey of Income and Program Participation (SIPP), also a Census Bureau survey. While it may be difficult to get the perfect estimate, any program dedicated to serving one of the most vulnerable segments of our society should start with having a realistic sense of who its potential beneficiaries are.

The Problem Of Medicaid And SCHIP Dropout

Health Affairs published the first paper in this SCHIP series (free access for two weeks) today as a Web Exclusive. In the paper, Ben Sommers of Brigham and Women’s Hospital reports that the number of uninsured children in the United States would fall by one-third if Medicaid and the State Children’s Health Insurance Program (SCHIP) simply retained all children who are enrolled and have no alternative coverage in a given year.

Using newly revised CPS data, Sommers finds that one-third of all children who were uninsured in 2006 had lost Medicaid or SCHIP coverage in the previous year. Among the subset of uninsured children in 2006 who were eligible for public coverage, more than two in five had lost public coverage in the previous year. Moreover, the problem of dropout from Medicaid and SCHIP is getting worse and is likely to accelerate even more because of the new 2006 federal requirement of increased citizenship documentation for Medicaid renewal.

Sommers calls for policy changes to combat dropout, starting with simplifying the Medicaid and SCHIP renewal processes as much as possible, and perhaps extending to integrating Medicaid and SCHIP in states that currently run them as two separate programs.

Tags: Children, Coverage