Arizona seeks to triple enrollment in a health care program for uninsured children, though much depends on a looming showdown between Congress and the president over funding.
The House and Senate voted out separate bills in July to increase funding — the House by $50 billion and the Senate by $35 billion over five years — for the State Children’s Health Insurance Program, otherwise known as SCHIP. The program covers children in poor families by providing states with a 3-to-1 matching grant.
Either bill would allow Arizona’s program, called KidsCare, to add some 130,000 children who qualify but are not on the rolls, said Anthony Rodgers, director of the Arizona Health Care Cost Containment System (AHCCCS).
“It looks like, yes, both versions would allow us to increase the number of children covered, so that we would be able to cover all kids who are currently eligible,” Rodgers said.
Current enrollment is about 64,000, Rodgers said. But Census data has helped AHCCCS officials identity a much larger pool of eligible but uninsured children. With the Legislature’s blessing, the agency will soon reach out to enroll as many of those children as it can.
KidsCare has a budget of $126 million for the current fiscal year, not counting administrative costs, according to the Joint Legislative Budget Committee.
What Washington will budget for SCHIP, however, remains unclear.
President Bush has threatened to veto any bill resembling what passed out of the House or Senate. He objects to the expansion of government-funded health care over private health insurance.
The president has proposed a much smaller $5 billion increase for SCHIP.
Rodgers said it was too soon to tell what Bush’s proposal would do to Kids-Care coverage. A lot hinges on formulas used to distribute money to the different states, he said.
AHCCCS lobbyist: Bush plan falls short
Citing a Congressional Budget Office report, AHCCCS lobbyist Monica Coury said the Bush plan falls about $9 billion short of maintaining current SCHIP enrollment levels nationwide. In short, children would lose SCHIP health insurance.
In Arizona, the Bush plan could also mean cutting enrollment, Coury said, but added details are too sketchy to say for certain.
“We do not know whether we would be able to maintain our current program,” she said.
As for expanding KidsCare, Coury said, “It would be questionable whether we would be able to sustain any outreach effort in any new population.”
Child advocate: Number of uninsured kids has decreased
Dana Naimark, president of Children’s Action Alliance, said KidsCare is a success, but said more children need to be brought on board.
“We’ve seen the rate of uninsured kids drop significantly,” Naimark said. “We’ve gone from 25 percent of underinsured kids in 1998, to 15 percent today.”
But she said half of Arizona’s remaining uninsured children would qualify for KidsCare.
This past session, the Legislature OK’d spending $480,000 for KidsCare outreach. The funding will come from money saved when enrollment is less than budgeted.
AHCCCS will contract for outreach efforts, Naimark said. Children’s Action Alliance has not decided whether to submit a proposal, she added.
The U.S. House and Senate bills could offer additional incentives to put more uninsured children on the rolls, Coury said.
In Arizona, children and their parents can now be told about KidsCare in public schools. The Legislature repealed the outreach ban with passage of a health care budget bill (S2789) late in the session.
Gov. Janet Napolitano — in an Aug. 10 speech at the state AFL-CIO convention in Phoenix — said KidsCare, because of the ban, “was the greatest secret that we had.”
A KidsCare expansion will require more than additional funding from Washington. The Legislature will have to kick in more as well.
“Yes, the state would have to come up with that portion of the match,” AHCCCS Director Rodgers said. “That’s the other part of the equation.”
Taxing tobacco
Both congressional proposals would fund spending increases, in part, by raising tobacco taxes — as much as 61 cents a pack in the case of the Senate. Arizona already taxes cigarettes by $2 a pack to finance increased AHCCCS coverage for adults, early childhood development and other programs.
Matthew Ladner of The Goldwater Institute, a nonprofit conservative think tank, said the tobacco tax falls too heavily on the poor.
“We’re asking low-income families to fund health care for the middle class,” Ladner says.
Naimark said the tobacco tax was a reasonable funding source.
Ladner said proposed increases in spending by Congress would turn SCHIP and KidsCare into government-run health care programs for the middle class. He said a family of four making more than $60,000 a year would qualify.
Currently, Arizona can enroll children from families making up to 200 percent of the federal poverty level — or $41,304 yearly for a family of four. Rodgers said proposed congressional funding would allow Arizona to increase the cap to 300 percent.
Some states like Massachusetts have already raised the cap to 300 percent.
At the state AFL-CIO convention, Napolitano said she proposed increasing KidsCare eligibility to 300 percent, but said the Legislature would not go along.
President Bush’s proposal would cap enrollment nationwide at 200 percent of federal poverty level, The Boston Globe said.
Program had ‘mission creep,’ critic says
The Goldwater Institute’s Ladner said Arizona’s KidsCare had suffered from what he called “mission creep.” For one thing, he said, Arizona covers adult parents, though the program originally was meant for children.
“That’s even more frightening,” Ladner said.
He said it provided an incentive for parents to drop their employer-provided health insurance.
Rodgers, however, cited figures showing that parents who have coverage are more likely to enroll their children, too.
More than $50 million was budgeted in 2008 for KidsCare parents, JLBC reported.
The two SCHIP bills in Congress have provisions on whether to cover adults, Rodgers said.
“The House is more flexible in the states covering adults on the SCHIP program, and the Senate is more restrictive,” he said, adding: “I haven’t looked at all the details, so I can’t give you a point-by-point difference.”
Congress will take up SCHIP again when it returns Sept. 4 from a month-long break. If disagreements or a veto prove too high a hurdle, funding for SCHIP stops after Sept. 30.
Rodgers, however, did not seem worried that money would be cut off completely. Current funding levels could be extended through a continuing resolution, he said.