July 7, 2009

Dear Partners, 

We have been following the latest developments in health reform and will pass along information to you as it becomes available.  It is imperative that health reform proposals work to improve children's health coverage, access and quality and do not leave children worse off than they are now.  

On June 10^th the Senate HELP Committee released its health reform bill and on June 19^th the House released its Tri-Committee draft bill (the Senate Finance Committee has not yet released its bill but it is expected later this week). Both bills work to expand coverage, control costs, and improve quality for all Americans, including children.   

Given that the Senate HELP Committee does not have jurisdiction over Medicaid and CHIP, its bill lacks information on how low-income children and families will receive coverage.  The bill does, however, include many provisions that will positively affect millions of children, including:

• Increasing support for immunizations, school-based clinics, trauma care, community health centers and other programs
• Creating a grant program for the implementation of medical homes
• Supporting an oral health prevention and education campaign
• Allowing group and individual plans to cover young adults as dependents until age 26 

The House bill also works to strengthen the health care system for children.   Positive improvements for children and families include:

• Automatically enrolling otherwise uninsured infants into Medicaid during their first year of life
• Strengthening reimbursement rates for Medicaid providers who treat children
• Allocating new federal funding for medical home pilot programs
• Providing enhanced funding for Medicaid eligibility systems 

While we believe that these legislative proposals are positive steps forward, there are certain aspects of the bills that we are concerned may be harmful for children.  With information from our partners at First Focus and the Center for Children and Families at Georgetown University, we outline some of these issues below, highlighting why they could be bad for kids and offering suggestions for improvement. 

Medicaid  

House

The House bill expands Medicaid eligibility to children up to 133 percent of the federal poverty level (FPL). (All six New England states already provide Medicaid coverage to children with income levels of at least 150 percent FPL.) Under this proposal, some children with income levels above 133 percent FPL could lose their Medicaid coverage and be transferred into a newly created Exchange.  Unless certain safeguards are established, children in an Exchange could see increased cost-sharing and reduced benefits. 

Senate HELP Committee

The Senate Finance Committee has jurisdiction over public insurance programs such as Medicaid.  However, the HELP Committee bill "assumes" that Medicaid would be provided to children with family income of up to 150 percent FPL. 

Takeaway Message: We must ensure that Medicaid benefits are protected for all currently enrolled children, an eligibility floor of at least 150 percent FPL is established, and coverage through the Exchange provides the comprehensive benefits and cost-sharing protections that children need. 

CHIP

House

The House bill requires states to maintain their CHIP eligibility rules, methodologies, and procedures through September 30, 2013.  At that time, CHIP would be dissolved and children would be moved into an Exchange.  The Congressional Budget Office estimates that at least 9.8 million children would be moved into the Exchange, where they could receive a less comprehensive benefit package and pay more for coverage.  

Senate HELP Committee

The HELP Committee bill does not address the future of CHIP.

Takeaway message: If the CHIP program is dissolved, we must ensure that an adequate transition plan is developed and that the Exchange provides coverage, cost protections, and benefits that are at least as strong as in CHIP. 

Benefit Package 

House

In the proposed House bill, all qualified health benefit plans for children would be required to include a list of covered services.  The bill outlines the specific list of covered services for children, yet this list inevitably falls short of EPSDT protections.    

Senate HELP Committee

The bill requires that all health plans cover preventative/screening services as defined by "Bright Futures", a preventive care model created by the American Academy of Pediatrics.  Health plans are expected to cover pediatric services, yet the bill does not provide details on what must be covered except for vision and dental care services. 

Takeaway message:  Children need a comprehensive benefit package to stay healthy.  Legislation should feature a clearly defined pediatric benefit package that is at least as inclusive and comprehensive as the EPSDT benefit plan. 

Affordability

House

The House bill establishes "affordability credits" to subsidize coverage for individuals and families with income up to 400 percent FPL. 

Senate HELP Committee

The Senate HELP Committee's most recent bill draft trims eligibility for subsidies from 500 to 400 percent FPL and increases the amount people in the top subsidy bracket would have to pay from 10 percent to 12.5 percent of income.  In the original draft, a person making about $40,000 would have to pay up to $3,200 for health coverage; in the new draft that ceiling is set around $6000.  We are concerned that these subsidies will be reduced even further when the HELP bill is reconciled with the Senate Finance Committee bill.  The most recent Senate Finance Committee outline suggests providing subsidies only up to 300 percent FPL. 

Takeaway message: Subsidies are an essential component of making health coverage affordable for families. We must ensure that health care is affordable for everyone by providing subsidies up to at least 400 percent FPL.  

Legal Immigrant Children 

House

The House proposal does not eliminate the current five-year waiting period that states can impose on legal immigrant children and pregnant women who otherwise would qualify for Medicaid or CHIP. 

Senate HELP Committee

The HELP Committee bill also does not eliminate the current five-year waiting period that states can impose on legal immigrant children and pregnant women who otherwise would qualify for Medicaid or CHIP. 

Takeaway message: We must guarantee that legal immigrant children do not lose coverage through new health reform legislation and that the gains that were made during CHIP reauthorization (CHIPRA's ICHIA provision gave states the option to eliminate the five-year waiting period in Medicaid and CHIP) are applied to all new and existing health insurance programs and structures, including an Exchange. 

National Health Reform Toolkit 

We also received some useful resources from our partners at CCF, CDF, First Focus and Voices for America's Children that we wanted to pass along.  We hope you find these helpful as you continue to make children's voices heard in national reform.

• Overall Messaging on Children in National Health Reform
• Sample Op-Ed
• Sample Letter to the Editor
• Sample Question for Meetings and Forums
• Recommended Improvements to the House Bill

Looking Ahead  

The Senate HELP Committee will continue marking up its bill this week.  The mark-up of the House Bill is scheduled to begin around July 13^th, and the Senate Finance Committee is aiming to release a bill this week.  We will continue to update you as the health reform process continues.  

We urge you to continue to make children's voices heard in national health reform. As always, please feel free to contact me (617-275-2929, arosenthal@communitycatalyst.org) directly with questions.

Sincerely,

Amy Rosenthal
Project Director