Children's health insurance program set to expire

Saturday, September 29, 2007 | 5:53 p.m. CDT; updated 8:22 a.m. CDT, Sunday, July 20, 2008

With a federal health insurance program for low-income children set to expire Sunday, legislators have been working to help states brace for the possibility that hundreds of thousands of children could lose health coverage if President Bush vetoes its reauthorization.

Meanwhile, Missouri health officials say they aren’t concerned about the fate of nearly 59,000 children enrolled in the State Children’s Health Insurance Program because they’re hopeful that a standoff between the president and Congress about a proposed expansion will get resolved before money runs out.

MC+ for Kids

The State Children’s Health Insurance Program, known as MC+ for Kids in Missouri, was established in 1997. It currently serves 6 million children annually, including 59,000 in Missouri. To be eligible in Missouri, children must be uninsured for at least six months and come from a family whose yearly income is up to 300 percent of the federal poverty level.

Anticipating a veto, Congress voted last week to continue funding for the program at its current level until mid-November as part of another bill keeping federal agencies in operating funds beyond Sunday.

“We firmly believe that it’s going to be taken care of and we won’t have a problem,” said Ana Compain-Romero, communications director for the Missouri Department of Social Services. “In the event that it’s not, we’ll start looking at things. But we’re optimistic.”

Known in Missouri as MC+ for Kids, the federally funded State Children’s Health Insurance Program was established by Congress and President Clinton in 1997. The program helps families who live near the poverty level but earn too much to qualify for Medicaid get health insurance for their children.

According to data from the U.S. Centers for Medicare and Medicaid Services, the program serves more than 6 million children annually. In 2007, about 59,000 Missouri children were enrolled in the program, including 1,308 in Boone County, Compain-Romero said.

The program provides states $5 billion a year in matching federal funds. Members of the House and Senate approved an expansion of the program last week that would increase spending to $60 billion over the next five years. Funding for the increase would come from a 61-cent increase on the federal excise tax on cigarettes.

President Bush has said he plans to veto the measure, arguing that the expansion of the program would put the nation one step closer to universal health care. He has instead proposed allocating the program $30 billion over the next five years.

Bob Quinn, executive director of the Missouri Association for Social Welfare, said he feels the program is too important to get caught up in politics.

“Some of the people who are against an expansion of SCHIP say it’s a person’s responsibility to pay for insurance, but not everybody has resources that are the same; not everybody’s medical needs are the same,” Quinn said. “To say we don’t want a government-run system, then I guess we’re going to get rid of Medicare. Why is it good for seniors, but bad for kids?”

Both the House and Senate passed their proposed expansion last week, but the House didn’t have the two-thirds majority it would need to override the expected presidential veto.

Mary Kahn, spokeswoman for the U.S. Centers for Medicare and Medicaid, which administers SCHIP, said her department sees the extension of the program’s funding through mid-November as a positive sign, and she doesn’t expect the program to be caught up in a political gridlock until then.

“Certainly if the program came to a screeching halt then the enrollees would suffer that loss,” Kahn said. “But I think it is certain that there will be a continuing resolution that will extend the life of the program while Congress and the president continue to work out their differences. The importance of this issue isn’t lost on anyone.”

The Congressional Research Service estimates that 12 states would have run out of money for the program by the end of October had the extension not been passed.

Missouri didn’t expect to be one of those, but how long the $72.1 million in federal funds Missouri received for fiscal 2008 will last after Sunday has yet to be determined, Compain-Romero said.

“We’ll probably start working on figuring that at the beginning of next week,” she said.

Officials in Iowa estimate that their federal funds used for SCHIP could run out before the end of the year.

If that happens, Iowa Department of Human Services spokesman Roger Munns said coverage of the 37,000 children enrolled in SCHIP in Iowa could be in jeopardy if the issue isn’t resolved soon.

“We’re hoping we won’t have to cross that bridge, but what if we have to? The answer is I don’t know,” Munns said. “There definitely is concern, but you just have to evaluate each step of the way. All the focus is on D.C. right now.”

In Missouri, some state money is used to match the federal funds for MC+ for Kids. But in the event money runs low, that state money can’t be used to keep the program afloat because the Missouri Health Improvement Act of 2007, signed by Gov. Matt Blunt in July, mandates that the program can only stay in effect if federal money is appropriated to help pay for it.

U.S. Rep. Kenny Hulshof, R-Columbia, originally backed SCHIP when it was established in 1997, but voted against the expansion last Wednesday because he said he disagrees with opening the program up to families with higher incomes.

“I would wholeheartedly support a straight extension of this important program. Unfortunately the Democrat bill is an unnecessary expansion of SCHIP,” Hulshof said in a statement.

Both Sen. Claire McKaskill, D-Mo., and Sen. Kit Bond, R-Mo., expressed support for the reauthorization last week.

Currently in Missouri, children under the age of 19 are eligible for MC+ for Kids if they have been uninsured for at least six months and if their gross family income is up to 300 percent of the federal poverty level. Thus, if a family of four makes less than $5,163 a month, or a total of $61,956 a year, their children could be eligible. If the family income is above 150 percent of the poverty level, monthly premiums ranging from $11 to $219 a month are charged.

Missouri is one of several states that allows children up to 300 percent above the poverty level to qualify, which is a number opponents have argued is too high. Advocates of MC+ for Kids are quick to point out, though, that those who qualify in that income bracket have to pay a monthly premium.

“Most people don’t understand that it’s not a giveaway,” said Jane Whiteside, organizer of the group Missouri Progressive Vote. “You pay for it, and it’s only available to people who can’t get affordable coverage elsewhere.”

Compain-Romero said her department views the state’s willingness to cover those who make up to 300 percent above the federal poverty level as a commitment to health care. That’s why, she said, the Missouri Department of Social Services is confident that even if the issue isn’t resolved anytime soon, Missouri will figure out a way to make sure children won’t get dropped.

“Our stance is that obviously it’s important for children to get any kind of medical attention they need and if parents have access to affordable health care, then they’re more likely to ensure children are getting things like preventative vaccines and well child visits,” she said. “We’ll be prepared one way or another.”

The Associated Press contributed to this report.

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