The Children’s Health Insurance Program is designed to
ensure that uninsured and lower-income children receive the health care they
need. Advocates are excellent at invoking the true face of children who need,
receive, and benefit from CHIP and SCHIP. Who doesn’t want to help children,
especially sick children?
Governor Rick Perry and the Texas state representatives, that’s who.
Alleging that this, “is not what I consider to be a piece of legislation that has the vast support of the people of the state of Texas,” Perry was clear that he did not support the bi-partisan twice-passed Senate plan to get up to 80,000 more children into the government-subsidized Children's Health Insurance Program.
He is likely to veto the measure, if it manages to make it to his desk. Unfortunately, even that is in question after the antics this week in the Texas Legislature when House Democrats halted action to kill the controversial voter ID bill. As a result, unfortunately, the CHIP bill, among others, was endangered. With the session close on the horizon, the Texas Senate worked late to pass the Senate version of the CHIP expansion bill by a vote of 29-2. They attached the bill to a newborn screening bill and returned it to the House.
The House simply needed to pass the bill. This seemed possible, since earlier they had approved Rep Garnet Coleman’s version of the bill 87-55.
However, on Thursday evening, Speaker Joe Strauss ruled that the Senate’s CHIP amendment was not germane to the bill it was attached to, and that, as they say, was that.
We can question and speculate for days about why the Senate attached the bill to the newborn screening bill instead of to Coleman’s CHIP bill, whether Strauss was right, or even if this is moot since Perry would veto the bill on its own or as an amendment.
I think it’s more important, though, to talk about the bottom line and why it’s essential that all Texans contact their elected representatives, as well as the Governor and Speaker, to express support for CHIP. That means talking about the myths versus facts of CHIP.
So…true…or false?
Point: The vast majority of Texans don’t support health care reform
FALSE! 2009 Polling data published by the Texas Hospital Association demonstrates that Texans consider making health insurance more affordable and accessible as the most important issues state leaders can address. 77% of Texans polled said that the Texas Legislature should make health care a priority, even though the national government will focus on it this year.
Point: Providing public health insurance and coverage is too expensive.
FALSE! The Henry J Kaiser Family Foundation researched this issue and found that, in fact, the amount spent covering the uninsured---not counting the hidden costs associated with it, such as higher care costs, increased premiums, and burden on local governments---is nearly the same as the cost to provide preventive care and coverage:
“Uninsured Americans could incur nearly $41 billion in uncompensated health care treatment in 2004, with federal, state and local governments paying as much as 85 percent of the care, according to a new Kaiser Commission on Medicaid and the Uninsured (KCMU) study. Even with uncompensated care, the study shows that people uninsured for the entire year can expect to receive about half as much care as people fully insured.
Another major finding of the study, authored by Urban Institute researchers Jack Hadley and John Holahan, is that if the country provided coverage to all the uninsured, the cost of additional medical care provided to the newly insured would be $48 billion—an increase of 0.4 percent in health spending’s share of the gross domestic product.
"Leaving 44 million Americans uninsured exacts a substantial price on society as well as individuals, while covering the uninsured would improve their health care without generating large increases in overall health spending," said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured.”
Point: The tax to pay for public health care or expansion of public health care, such as raising the enrollment for CHIP would be too big a tax burden on citizens who use private health insurance.
FALSE! Actually, it’s more of a misunderstanding and lack of knowledge about how the system works when it comes to insured versus uninsured. FamiliesUSA released an important report with some staggering facts and figures:
“While people without health insurance often delay or forgo care, in 2008, the uninsured received $116 billion worth of care from hospitals, doctors, and other providers. Those costs were covered in the following ways:
· The uninsured paid for, on average, more than one-third (37 percent) of the total costs of the care they received out of their own pockets.
· Third-party sources, such as government programs and charities, paid for another 26 percent of that care.
· The remaining amount, approximately $42.7 billion in 2008, was unpaid and constituted uncompensated care.
To make up for this uncompensated care, the costs were shifted to insurers in the form of higher charges for health services. These higher charges are then passed on to families and businesses as higher premiums. The impact of this hidden health tax on annual premiums for families and individuals in 2008 was as follows:
· For family health care coverage, the hidden health tax was $1,017.
· For health coverage provided to single individuals, the hidden health tax was $368.”
Add it up: you are incurring an additional “hidden health” cost burden of over $1000 each year due to covering for uncompensated care.
When people---especially children---do not have access to covered health care, they tend to forgo preventive and well-care. They tend to delay accessing health care. This means when a person finally arrives---often to the ER---to receive treatment, they are sicker and require more and more costly care. Uncompensated care. That someone has to pay for. So that burden is passed on to you and me by virtue of inflated cost of care and higher premiums. It’s passed on to local, state and federal governments---drawing budget dollars away from other public services, essential ones, such as police, fire and roads.
In fact, for example, city budgets get hit in two ways, both on the insured and uninsured fronts. Because of elevated cost of providing health care to city employees plus the city’s coverage of the uninsured through mandatory programs such as vaccinations, cities are cutting other public programs such as funding to libraries or slashing budgets to police.
Point: If we just didn’t provide health care to anyone and if government stopped paying for it entirely, it would be fine.
FALSE! First, you could incur a public health crisis if government quit ensuring, for example, that everyone had access to vaccinations. Second, laws require hospitals and doctors to provide care. Without compensation, our health care system would quickly collapse. Health care is truly a civic issue. The recent swine flu panic is a good, current example of that.
Point: Well, I see how we need to help sick kids, but expanding the program and upping the annual family income so more kids qualify costs too much.
FALSE! The Congressional Budget Office (CBO) released a memo with revised estimates and cost projections for SCHIP. It was interesting to see the budget two-step that states do when they exhaust their SCHIP funding. In that case, states expand Medicaid, which costs more. The CBO noted:
“The provision of additional SCHIP funding would keep states from expanding Medicaid eligibility, and thus generate about $500 million in savings in the Medicaid program. As a result, the net federal cost ($700 million) of providing funding to maintain existing SCHIP programs is lower than the amount of additional SCHIP funding required ($1.2 billion).”
Point: Expanding access to CHIP causes crowd-out (substitution of public coverage for private coverage)
FALSE! CHIP has regulations---fairly strict ones that are frequently reviewed---that all states must follow to minimize crowd-out. The US Government Accountability Office, Centers for Medicare & Medicaid Services' (CMS) and the states oversee this. In March of this year, the GAO undertook a review of the CMS efforts to minimize crowd-out. In short, despite challenges of measurement, the GAO found that most officials did not find crowd-out to be a concern. They based this on many factors, "including the lack of available and affordable private health insurance for the SCHIP population in their state."
This means that people are not opting in to SCHIP to get cheaper coverage on the dole's dime. Instead, it means that people are grasping at a last opportunity for available and affordable access to covered health care for their children.
The GAO's recommendation is to take a step back and assess whether concerns about crowd-out are warranted.
That's a big step. The initial false presumption is that the concern is warranted because it is a serious problem. In truth, it may not be at all, and it's important to evaluate this honestly because with the economy going down, more and more families are finding themselves without health insurance.
The clear pattern here is that the uninsured need health care and will seek it out, at least eventually. That costs more. It leaves a much too large uncompensated care burden on health care providers. To compensate for that, they pass along increased costs to patients and insurers. To compensate for that, insurers increase premiums. Government provides, but at the expense of its own budget, but without a public health budget, it compensates by pulling from other pools, such as public libraries or protection programs, or by expanding other programs that are not cost effective delivery vehicles for health care.
It is costing us right now to not provide health care to the uninsured. It is costing us too much because we’re spending what we do not have.
If we budget and provide for this existing expense, it will cost less overall and be more fiscally responsible.
That’s just being smart with money.
That’s also just ensuring that we create the best public health situation possible.
If swine flu and other epidemics teach us anything, it’s that germs don’t check income levels or insurance cards before hitting, but untreated diseases spread much faster than those treated and kept in check.
It’s fiscally responsible and socially responsible to ensure that all citizens can access covered health care.
Unfortunately, 80,000 uninsured children in Texas who could have benefited from the CHIP bill and amendment are instead once again at risk.
Anne Dunkelberg of the Center for Public Policy Priorities said, “Right now,
affordable health insurance for 80,000 uninsured children is in jeopardy
because state leaders think it's not a priority--for you. We were all
tremendously disappointed – though not surprised – when the House returned the
bill onto which the Senate had amended the CHIP bill to the Senate for
technical reasons. There are very few
options left to pass the CHIP bill again – even though the bipartisan bill
already passed both chambers with solid majorities. This bill has been held up by politics, not
its merits!"
The Center for Public Policy Priorities, the CHIP Coalition, and the Children’s Defense Fund have asked concerned citizens to contact Governor Perry and Speaker Strauss to express their support of CHIP.
To reach Speaker Strauss, call 1.888.327.2086. To reach Governor Perry, call 1.888.746.9714. To find your local legislator, check this Web site.
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