High Stakes for Maryland’s Children as Health Care Reform Moves Ahead
By: Health Insurance
Submitted: 2009-12-05 11:09:47 | Word Count: 719
Another health care reform milestone was passed when the U.S. Senate secured the 60 votes necessary to bring the health care debate to the Senate floor. The debate on the Senate bill is expected to last weeks, with the Senate leadership hoping for passage before Christmas. Negotiations to reconcile differences between the final Senate version and House bill, H.R. 3962 that passed November 7th, could begin in January.
Children’s Health Insurance
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Discussion of children’s health coverage in the context of federal reform has centered on how to handle the Children’s Health Insurance Program (CHIP). In February, Congress reauthorized CHIP through 2013. The legislation, originally enacted a decade ago, has expanded access to health insurance for millions of low- and moderate income children who would not other wise have access to coverage.
The Senate bill under consideration extends CHIP until 2019, although funding for the final five years is not included. Under the House bill, children under 150 percent of the Federal Poverty Level (FPL) will go into Medicaid, which includes various protections for children. However, children above 150 percent FPL will be transitioned into Exchanges, in which people without access to affordable coverage through an employer can purchase health insurance. A major concern is that the Exchanges may not include the same protections as Medicaid and that families will pay more than they currently do under CHIP.
Because of a quirk in the House legislation, the stakes for Maryland’s children are not quite as high. When CHIP was first created, Maryland chose to expand Medicaid rather than create a separate system. Thus, children in the Maryland Children’s Health Program have all of the same protections as those in Medicaid. For Maryland, and other states that did a so-called Medicaid expansion, the House legislation requires that CHIP children be kept in Medicaid, rather than moved into the Exchanges.
Advocates for Children and Youth, working with sister organizations from across the country and national partners like First Focus and Voices, is urging Maryland’s federal delegation to ensure a strong benefit package and coverage protections for all children, whether enrolled in Medicaid, CHIP or the Exchange.
Other Critical Issues for Children
In additional, ACY would like to see the following provisions included in the final legislation:
* Investments to support home visiting programs;
* Investments to support school-based health centers;
* Investments to support community preventive services;
* Investments to support the public health infrastructure;
* Investment in an oral health prevention campaign;
* Extension of Medicaid coverage for all foster youth below age 25 who were formerly in foster care for a period of six months;
* Streamlining of enrollment under Medicaid, CHIP and the Exchange;
* Collection and reporting of data by race, ethnicity, primary language and other categories for any ongoing or new federal health program;
* Federally financed increased Medicaid primary care provider rates;
* Prohibition of pre-existing condition exclusions;
* Elimination of annual and lifetime limits; and
* Inclusion of the public option.
Help for Families
Major aspects of the House and Senate legislation include help for adults, which is good for children. Insured parents are more likely to ensure that their children get health care, and healthy women have healthier pregnancies and healthier babies.
The current Senate bill and the final House bill both contain versions of a “public option”, although the Senate bill allows states to opt out. Both bills require people to buy insurance or pay a penalty. Subsidies are available through the Exchange to households earning up to 400 percent of the poverty level, or $88,200 for a family of four.
The Senate bill expands Medicaid to cover everyone earning less than 133 percent of FPL, or $29,327 for a family of four. The House bill expands Medicaid to cover households earning less than 150 percent of the FPL, or $33,075 for a family of four.
Each bill bans coverage denials based on pre-existing conditions. Both also include bans on annual and lifetime limits, and premiums disparities based on health status and gender.
