“Embarassing” was a frequent comment I heard when I was in DC earlier this week, made by various legislative staff of California lawmakers. The subject was the new waiting list, reported by the Sacramento Bee (source of the photo) and elsewhere, in Healthy Families program which has begun denying children the health coverage they need.
Despite budgets ravaged by the recession, at least 13 states have invested millions of dollars this year to cover 250,000 more children with subsidized government health insurance.
The expansions have come in the five months since Congress and President Obama used the reauthorization of the Children’s Health Insurance Program to vastly increase its funding and encourage states to increase enrollment. Although the federal government covers the vast majority of the cost, states set their own eligibility levels and must decide whether to spend state money in order to draw even more from Washington.
The states’ willingness to spend, even under excruciating budget pressures, is a measure of the support for expanding health care coverage to the uninsured as Congress and the administration intensify their negotiations over a new federal health care bill.
But a number of states decided that their depleted coffers did not allow them to insure additional children, even as a minority partner.
…in California, where Democratic legislators and Gov. Arnold Schwarzenegger, a Republican, are struggling to close the country’s largest budget gap, the state on Friday imposed a freeze on new enrollments.
California officials estimate that up to 350,000 eligible children may be relegated to a waiting list, and that attrition could lower enrollment by 250,000 by June. If money is not found, the losses there might overwhelm the cumulative gains in other states.
Health and Human Services Secretary Kathleen Sebelius said the potential for major reductions in California was “a huge concern.”
But over all, she said, the Obama administration was “very pleased that even in what are some of the worst budget times in a very long time, children’s health insurance continues to be an absolute top priority.”
The Children’s Health Insurance Program, known as CHIP, has been politically popular since its enactment in 1997 because it primarily benefits working families that earn too much to qualify for Medicaid but too little to afford private insurance.
In many states, eligibility expansions have passed with solid bipartisan support. In one of her final acts as governor of Kansas in April, Ms. Sebelius, a Democrat, signed a two-year expansion worth $4.4 million that had been approved by her overwhelmingly Republican Legislature…
Forty-eight states faced budget shortfalls this year, totaling $121.2 billion, according to the National Conference of State Legislatures. But in those that have managed to expand eligibility, governors and legislators said they viewed CHIP as a cost-effective investment.
“In a downturn, the number of people who need the safety net increases,” said Gov. Bill Ritter Jr. of Colorado, a Democrat, whose state levied $600 million in fees on hospitals, some of which will be used to cover an additional 21,000 children.
In Alabama, Democratic legislators overrode the veto of Gov. Bob Riley, a Republican, to extend coverage to 14,000 children at an additional cost to the state of $8 million.“Our economy is tough here,” said State Senator Roger H. Bedford Jr., a Democrat. “But our decision was to fund the health care needs of our children because a healthy child learns better and they don’t show up at the emergency room needing acute care.”
Other states expanding eligibility include Arkansas, Indiana, Iowa, Montana, Nebraska, North Dakota, Oklahoma, Oregon and West Virginia. Ohio passed a budget last week that includes an expansion, but its financing depends on the resolution of a court case.
Illinois, New York and Wisconsin, which had been paying for expansions with state money, are now applying for federal matching funds. And many states are enacting measures to make it easier for children to enroll and stay enrolled, steps encouraged by the federal legislation. Officials in those states and others said they had little choice but to leave federal money on the table.
In California, the Legislature beat back Mr. Schwarzenegger’s proposal to eliminate CHIP altogether but seems to have accepted the enrollment freeze.
“It is heartbreaking,” said Ginny S. Puddefoot, deputy director of the agency that administers the program there. “For those of us involved with children’s health care, this is just something we never imagined we would see.”