December 9, 2008
Dear Partners,
During this time of political transition and economic uncertainty, we want to update you about some important federal health care issues. In this Alert we have included information about a potential FMAP increase in an economic stimulus package, SCHIP reauthorization, and efforts related to national health reform.
We also wanted to let you know about the roles that Community Catalyst and NEACH intend to play in national health reform. While NEACH will remain committed to our work on SCHIP, we also plan to become engaged in broader health reform issues related to children's health. Many of you have expressed an interest in continuing to work together regionally on federal issues, and this provides another excellent opportunity to do so.
In addition, Community Catalyst will be developing resources and mobilizing partners in 30-35 states across the country on issues related to health reform. We will be sure to forward relevant information to all of you.
FMAP Increase in Stimulus Package
With the economy in recession, the 111th Congress and the Obama administration will act quickly to enact an economic stimulus bill in January. States will very likely see a temporary increase in the Federal Medical Assistance Percentage (FMAP) as part of the economic stimulus package. As a reminder, FMAP is the percent of state Medicaid expenditures that the federal government reimburses to states; wealthier states tend to receive a reimbursement rate of 50 percent, while states needing more assistance can receive up to 75 percent. Generally, states would only be eligible to receive an FMAP increase if they meet certain criteria, such as agreeing not to reduce Medicaid eligibility.
Temporarily raising the FMAP would increase Medicaid funding to states during this economic downtown, preserving vital health services at a time when state governments-facing large and growing budget deficits-are threatening cuts. It is very likely that states will need to agree to keep their eligibility at current levels in order to receive the funds. The size of the increase, as well as the duration of the increase, has not yet been determined (although a two-year period is looking increasingly likely). We will keep you posted as we hear more.
ACTION STEP: Please contact your members of Congress (contact information for the New England delegation can be found here) and let them know that an FMAP increase could provide valuable resources for states during this difficult economic time.
SCHIP
SCHIP First v. SCHIP as Part of National Reform
As you all know, SCHIP is set to expire on March 31, 2009. We have repeatedly heard that the new President and Congress have made reauthorizing the program one of their top priorities. Rahm Emanuel, President-elect Obama's incoming chief of staff, stated in a Wall Street Journal article that SCHIP is one of the first pieces of legislation that Obama expects to sign as President. There has been a great deal of discussion about whether SCHIP should be addressed on its own or part of national reform. We believe it should be addressed independently for several reasons:
- 1. SCHIP is unfinished business of 2008, and we should quickly reauthorize the bill so we can move on to other priorities.
- 2. We are all facing touch economic times in our states. More children and families must now rely on public programs. We need to ensure that programs like Medicaid and SCHIP are stable and secure and can meet increasing demand.
- 3. Even though many Members of our Congressional delegation are pushing for quick action on national reform, it is likely that national health reform will take time to work its way through Congress. We want our states to have the security and commitment they need from the federal government so they can plan accordingly and continue strong public programs for children during this recession.
Vehicle for Moving SCHIP
There are several potential vehicles for SCHIP: it could be included as part of the economic stimulus package that will be addressed very early on in the 111th Congress or as a stand alone bill. Most recently, it sounds more likely that it will be part of the economic stimulus bill, although there is still debate about this. In either case, there are three options regarding the state of the bill: a full, long-term, five-year program reauthorization; a more short-term reauthorization (2-3 years); or a short-term extension. Some believe that Congress will favor one of the short-term options, delaying full reauthorization until a comprehensive health reform package is developed. A number of state officials and advocates have expressed disappointment with this idea, noting that a short reauthorization makes planning future budgets more difficult.
While we do understand that concern, we believe a short-term reauthorization would be satisfactory. A quick, non-controversial passage will provide us with an early win on children's health and help pave the way for national health reform. When development of a large scale reform package gets underway, advocates and elected officials will have a subsequent opportunity to push for further provisions for children and families. We do, however, remain committed to the belief that a full five-year reauthorization would be best for our children, families and states.
Overview of the Bill
There has been and will continue to be extensive discussions about what the SCHIP bill should look like. While we would love to see a perfect bill, we believe it is more imperative to get something done quickly rather than risk political infighting and delays. We believe that CHIPRA I, the first version of the bill that was voted on and passed by the entire Congress, is the most likely option for a 2009 SCHIP bill. There may be some limited opportunities to enhance the bill, and there are also some preliminary conversations on the Hill about possibly increasing the SCHIP matching rate. There are very few details available at this point, but we will keep you posted once there is more clarity on these issues.
ACTION STEP: Please call your delegation (contact information for the New England delegation can be found here) to let them know how important it is to you and your organization that we see a quick reauthorization of SCHIP. Whether the bill is part of the stimulus package or a free-standing bill, we would like to see early action.
Suggested talking points:
• SCHIP has been an enormously effective, bi-partisan program that provides high-quality, accessible health care for millions of America's vulnerable children.
• During these difficult economic times, children, families and states are relying on SCHIP more than ever. We need to ensure that the program remains strong and secure by taking early action to reauthorize it.
• I am asking Senator/Representative _______ to support the quick passage of an SCHIP reauthorization bill at the beginning of the new Congressional session.
National Health Reform Plans
It appears that national health reform efforts are moving forward. A Reuters article from December 5th noted that Tom Daschle, Obama's lead on health care and nominee for Health and Human Services Secretary, has begun talking with consumers, businesses, and health and labor groups about their views on health reform. Senator Daschle is expected to begin detailing the Administration's health reform plans in the coming days.
On November 12th, Senate Finance Committee Chair Max Baucus (D - MT) released an 89-page white paper describing his proposal for reforming the American health care system. Senator Baucus' plan requires all Americans to eventually attain health coverage, with the federal government providing insurance subsidies to low-income individuals. The plan also calls for the creation of a national health insurance exchange and the expansion of Medicaid and Medicare.
The white paper proposes expanding SCHIP to cover all uninsured children in families with incomes at or below 250% FPL ($44,000 for a family of three). This would raise the income limit for SCHIP eligibility in about half of all states. We were pleased to see that Senator Baucus' proposal also allows states to cover children over 250% FPL. This is a positive sign from the Senate Finance Chair and will be an important provision for five New England states at or above 250% FPL (CT, MA, NH, RI, and VT).
You can read summaries of Senator Baucus' plan from Community Catalyst and Georgetown's Center for Children and Families for additional information.
Senator Ted Kennedy (D - MA) is also hard at work formulating his own health reform plan. John McDonough, former executive director of Boston-based Health Care for All and key architect of Massachusetts health reform, is playing a senior role on the Senator's reform team. While Kennedy has not yet released the details of his plan, he outlined his hopes for reform in this recent Washington Post editorial.
Community Catalyst and NEACH in National Reform
Community Catalyst's main contribution to the health reform movement will be to provide direct technical assistance and educational materials to state-based groups involved in health reform efforts. Community Catalyst will support state partners by helping them build and mobilize coalitions, understand health policy proposals, and strategize ways to educate the Congressional delegation about issues important to consumers. Community Catalyst has created a handbook for state advocates sharing lessons learned from the 1993-4 health care reform effort and offering suggestions for maximizing your involvement in the 2009 debate.
NEACH will continue to promote SCHIP reauthorization and expansion, but will also become increasingly engaged in more large-scale health reform, specifically focusing on how reform efforts address and affect children's health. We will work with our policymakers and elected officials to support a reform package that focuses on ways to promote children's health quality, access, and coverage.
Action Step Overview
- Contact your members of Congress and let them know that an FMAP increase could provide valuable resources for states during this difficult economic time.
- Call your delegation to let them know how important it is to you and your organization that we see a quick reauthorization of SCHIP.
We will keep you informed about these important health care issues as we learn more in the coming weeks and months. As always, thank you for your dedication and hard work. Please feel free to call (617-275-2929) or email (arosenthal@communitycatalyst.org) me directly with questions.
Sincerely,
Amy Rosenthal
Project Director
