The purpose of this paper is to analyze the US Childrens Health Insurance Program in terms of its effectiveness in reaching out to uninsured children across the states. The fiscal impact of the program on state budgets and assessing the impact of the 2009 CHIP reauthorization act vetoed this year by the current president will be undertaken. The review of the SCHIP programs will be conducted through analytical assessment of specific states including Pennsylvania, North Carolina, Missouri and California. The items that will be targeted in the review will be the budgetary allocations of CHIP on annual basis per state since 1997.
It will also assess the extent of flexibility that individual states have adopted on the eligibility policies and requirements for individuals. Information on the policy review will be searched from the Congress catalogues and the individual states statutory provisions for children health care. The discussion will include the creation of CHIP. It will also include the amendments that have been made on the policy since its adoption. The review will also address the impact the changes on health reforms by the Federal Government assented by the president in October. In order to assess its effectiveness, the rising cases of uninsured children in the different states will be addressed by exploring the efforts individual states are making to make health care accessible to all children. The conclusion will address the performance of CHIP in the last five years and propose recommendations that can be adopted to make the Act more effective in fulfilling its purpose.
Over the first ten years, the federal government has been cost 40 billion by SCHIP, and the controversy over its fiscal impacts echoes a dispute that is larger in the United States regarding the role of the government in health care (Beth and Fouhy, 2007). Considering researches from Arizona State and Brigham Young University by Beth and Fouhy (2007), it indicated that children drop out of SCHIP because they move to emergency care situations that are more frequent from infrequent routine care. Any attempt to minimize the overheads of a state health care program could create false-savings because children who need care and lose insurance coverage are taken care of by other government organizations.
SCHIP in its current form has numerous provisions that may have a fiscal impact. These provisions include new funding formula Identity Documentation Requirement federal sponsoring for immigrants that are newly qualified other options for increasing coverage provisions that restricts SCHIP from funding Certain Groups and New State Reporting Requirements. Directors of SCHIP mainly focus on the effect to a health insurance firm. In analysis by Espe and Erik (2007), they concluded that for every 100 children who benefit from SCHIP, there is an equivalent diminution in a private-coverage between 25 and 50 children. This is speculated by the CBO because benefits that are better are being offered by the state programs at lower costs with comparison to other alternatives.
Assessing the impact of the 2009 CHIP reauthorization act vetoed this year by the current president
Democrats increased majorities in both Houses of congress in the awake of President Obamas inauguration. Statutory leaders acted quickly to breakage of political deadlock over expansion of SCHIP. On 14th of January 2009, H.R. 2 was passed by the house a 290-138 vote. Spending additional 32.8 was authorized by the bill so as to increase the health coverage program to add approximately additional 4 million children and cover first-time legal immigrants without a waiting period. This increased tax on cigarettes, chewing tobacco as well as other tobacco products to sponsor the expansion of the program. The house bill with two amendments was passed by the Senate on January 29 and the bill was signed into law by President Obama on 4th February 2009. The current President vetoed this reauthorization act because there was a 61 percent increase in federal exercise tax on tobacco products and cigarettes so as to double the federal sponsoring of SCHIP. More so, imposition of increased federal tax can lead to a net-increase in General Fund Revenues (increase in sales tax and reduction in revenues collected) to approximately 9.3 million (Shailagh and Jonathan, 2008)
Review of literature
The Budgetary allocations of CHIP had to conform to the balanced-budget agreement that existed between the White House and Congress. As James and Carney (1997) assert, Pressure to reduce the amount of grants involved was on, with a possible compromise of 16 billion instead 24 was argued by First lady Clinton Hillary. The administration of Clinton had to deal with the leadership of the republicans in Congress that prohibited amendments to be backed to resolutions of the budget. President Clinton inquired from members of the Congress whether Childrens Health Insurance Provision should be demolished. It was so done on May 22 with the amendment of cigarette tax that was necessary being defeated. As per argument of First lady Hillary, the overall budget proposal had to be safeguarded by the President.
Kennedy was angered and surprised as he considered it as a betrayal saying that Vice President Al Gore and President Bill Clinton had not been returned. Kennedy insisted that they shall again and again offer till they prevail. It is of good that children are protected than protecting the tobacco industry. Both Hillary and Bill Clinton suggested that subsequent amendments should include Childrens Health Insurance. Hatch and Kennedy as Michael and Crowley (2004) describe, revived the bill after its defeat and its passage was lobbied by Girl Scout for the USA and Childrens Defence putting pressure on the congress. SCHIP was approved and signed into law by President Bill Clinton on 5th August 1997 as fraction of the Balanced Budget Act of 1997, which had to take effect the subsequent month. Hillary Clinton had given an assistance that was invaluable both in the shaping and the fashioning of the program and acted as a clear advocate.
According to James and Carney (1997), SCHIP is under Title IV caption J of H.R. 2015 (105th) Balanced Budget Act of 1997. Rep John Kasich R-OH initiated and funded H.R. 2015 with no co-sponsors. On 25th June 1997, House Vote Roll241 was passed by H.R. 2015 mainly among partisan lines, 162 nays and 270 ayes, with most Democrats being in opposition. Unanimous consent bill was passed by the Senate in the same day. Passage in both Senate (Roll 209) and House (Roll 209) became more bipartisan (James and Carney, 1997).
Extent of flexibility that individual states have adopted on the eligibility policies and requirements for individuals
SCHIP is in partnership between state governments and federal. Individual states run these programs according to the requirements that set by federal Centres for Medicaid and Medicare Services. Individual states are able to develop their SCHIP programs as programs that are independent and separate from Medicaid (a child health program that is separate), use funds from SCHIP to enlarge their Medicaid program (Medicaid expansion programs in SCHIP), or merge these approaches (combination programs for SCHIP). Enhanced federal funds are received by states for their SCHIP programs at a rate that is above the Medicaid match that is regular.
States had developed SCHIP programs by February 1999, but it needed effort to enrol children. The Clinton administration implemented an Insure Kids Now campaign to enrol more children this campaign was under the Health Resources and Services Administration. As Susan and Milligan (2008) puts it, more than one million children had been enrolled by April 1999, and a goal was set by the Clinton Administration to raise this figure to 2.6 million by the year 2000. Section 42 of Federal-Regulations, Section 457 described regulations that are followed by States with separate child health programs, which have much more flexibility than Medicaid programs as they can utilize an enormous deal of enrolment matters and flexibility in eligibility. The regulations describe the limits to this flexibility, and states like Pennsylvania, North Carolina, Missouri and California ought to describe their qualities of their program in their SCHIP state policies. 43 out of 50 state governors support renewal of SCHIP (Susan and Milligan, 2008). States like California, Pennsylvania, Missouri and North Carolina have integrated usage of private companies to oversee sections of their SCHIP benefits. These Medicaid managed care programs permit health maintenance organizations and insurance firms that are private to deal directly with the Medicaid department of a state at a price that is fixed per enrolee. The health policies then enrol individuals that are eligible into their programs and become liable for guaranteeing that SCHIP benefits are delivered to beneficiaries that are eligible.
In California and Missouri, funds from SCHIP are used to increase eligibility for the states Medicaid programs. Therefore, all Medicaid regulations and rules (including benefits and cost sharing) apply. States like Pennsylvania and North Carolina are permitted to use funds from SCHIP and Medicaid for premium-assistance programs that assists eligible-individuals to purchase health insurance that is private. Few states like North Carolina and Missouri had premium-assistance programs, and had a relatively low enrolment however interest in this approach is still high. Therefore, this rule was not compassionate to those children that could otherwise survive without medical insurance Susan and Milligan (2008).
The impact the changes on health reforms by the federal government assented to by the president in October will have on the administration and effectiveness of the program
The extent to which SCHIP is enrolled as Karen and Massimo (2008) explains is determined by reductions in private coverage. This can assist in assessing the expenditure of the federal government and the overall effects of the program in reducing the number of uninsured children. SCHIP makes private coverage not important for some families and increases the chances of low income families to take jobs that offer higher wages. SCHIP influences employers actions. If employers of low-wage employees accept that SCHIP makes insurance to be of less importance some may reduce their level of benefits offered stop offering insurance and reduce their contributions to the premiums for family coverage. Most employers retort to SCHIP by declining to offer coverage increasing premiums and reducing benefits. This will have a greatest impact on the effectiveness and administration of the program by the federal government.
Discussion
Creation of SCHIP
SCHIP program was implemented with the aim of covering children that are uninsured in families with modest incomes than cannot qualify for Medicaid. SCHIP was created in 1997 and was the largest extensive of taxpayer that sponsored health insurance cover for United States children (James and Carney (1997).
The amendments that have been made on the policy since its adoption
The authority that was legislative for SCHIP is under chapter XXI of the Social Security Act (Phyllis and Schlafly, 1997). During Clintons administration, Senator Hatch Orrin in a partnership with Senator Ted Kennedy and with the help of Rodham Hillary Clinton sponsored SCHIP. Each state was given flexibility in amending its own policies and requirements of SCHIP eligibility within federal guidelines that are broad. Some states got authorities to legislative provision waivers to use the funds from SCHIP to include parents of children that are benefiting from both Medicaid and SCHIP, other adults and pregnant women. During the federal fiscal year 2006, As Phyllis and Schlafly (1997) observed, SCHIP had covered 670 thousand adults and over 6.6 million children and each state had amended its own strategy. During the administration of President Bush, He vetoed two attempts to increase the sponsoring the SCHIP. Childrens Health Reauthorization Act of 2009 was signed on 4th February 2009 by President Obama Barrack, so as to amend the health insurance program to include additional four million pregnant women and children, these also included first-time legal immigrants without a period that is waiting (Shailagh and Jonathan, 2008).
President Bill Clinton proposed a new initiative during his State of the Union Address in 1997, with an objective of covering at most 5 million children. Much of the bill was written by Kennedy using tax paid from tobacco. Republican Senator Hatch Orrin was brought into the statutory by Kennedy to act as a co-sponsor. Hatch commented that, Children are terribly being hurt and perhaps scared for the rest of their lives, and it was the moral-responsibility of the nation to cover them (Phyllis and Schlafly, 1997). The amendment bill was criticized by Republicans as being a prerogative program that is open-ended however it was planned as a block grant but not an entitlement. Senator Lott Trent really opposed the measure terming it as a government program that will not pass.
The administration of Clinton had to deal with the leadership of the republicans in Congress that prohibited amendments to be backed.
The efforts individual states are making to make health care accessible to all children
Individual states are using expansion that is under Medicaid, programs that are separate and a combination of the two approaches. Each state gets an annual allotment for SCHIP basing on an approximation of the target population and an adjustment that reflects costs of medical services. When SCHIP was first designed, the formula for allotment was based on uninsured children that are in families with low-income. Each state spends it own allotment in a period of three years. Unspent funds are redistributed to those states that spent all their funds.
Strength and weakness of CHIP
The main strength of SCHIP Phyllis and Schlafly (1997) observes is that it has a success of insuring children. States can enrol children by increasing their Medicaid program, creating a program that is separate, under SCHIP or designing a combination of the 2 approaches. SCHIP has a weakness of crowding out to use technical terms. Espe and Erik (2007) estimated that 60 percent SCHIP beneficiaries of the government efforts to minimize the number of uninsured are already insured by private firms. Public insurance programs are not effective because their costs are being shifted to taxpayers. For example, SCHIP is prevalent with abuse, waste and fraud. The programs administration is bad as it can cover Viagra for sex offenders serving time. Moreover, the quality of care can be awful, with beneficiaries not being able to either access specialist or have an idea of the number of prescriptions they can receive every year.
Conclusion
Since SCHIP inception, 40 billion has been provided by the congress for it. In 2006, SCHIP enrolled about 6.6 million children as well as 670,000 adults through legislative provisions waivers. SCHIP is not authorized to continue under The United States Current law after 2007, and the Congress considered reauthorization of the program. In 2006, the highest eligibility threshold in a state was 350 percent of their level of poverty and the lowest was 140 percent. Each subsequent year, the federal sponsoring of SCHIP on each state is based on formula that accounts the childrens number in families with low income, the number of uninsured children and each states wages in the health service sector. Unspent funds are re-distributed to states that have exhausted their allotments.
Recommendations
In order to make the Act to be more effective, one can suggest that they should be the option of Modifying SCHIP. Reauthorization gives the congress an opportunity to consider alterations in SCHIP, which include State efforts to enrol uninsured children, Target population should be redefined formula to allocate funds should be changed rules for re-distribution of unspent funds should be modified re-examining SCHIP matching rate and the benefits that states are to provide should be modified.
It will also assess the extent of flexibility that individual states have adopted on the eligibility policies and requirements for individuals. Information on the policy review will be searched from the Congress catalogues and the individual states statutory provisions for children health care. The discussion will include the creation of CHIP. It will also include the amendments that have been made on the policy since its adoption. The review will also address the impact the changes on health reforms by the Federal Government assented by the president in October. In order to assess its effectiveness, the rising cases of uninsured children in the different states will be addressed by exploring the efforts individual states are making to make health care accessible to all children. The conclusion will address the performance of CHIP in the last five years and propose recommendations that can be adopted to make the Act more effective in fulfilling its purpose.
Over the first ten years, the federal government has been cost 40 billion by SCHIP, and the controversy over its fiscal impacts echoes a dispute that is larger in the United States regarding the role of the government in health care (Beth and Fouhy, 2007). Considering researches from Arizona State and Brigham Young University by Beth and Fouhy (2007), it indicated that children drop out of SCHIP because they move to emergency care situations that are more frequent from infrequent routine care. Any attempt to minimize the overheads of a state health care program could create false-savings because children who need care and lose insurance coverage are taken care of by other government organizations.
SCHIP in its current form has numerous provisions that may have a fiscal impact. These provisions include new funding formula Identity Documentation Requirement federal sponsoring for immigrants that are newly qualified other options for increasing coverage provisions that restricts SCHIP from funding Certain Groups and New State Reporting Requirements. Directors of SCHIP mainly focus on the effect to a health insurance firm. In analysis by Espe and Erik (2007), they concluded that for every 100 children who benefit from SCHIP, there is an equivalent diminution in a private-coverage between 25 and 50 children. This is speculated by the CBO because benefits that are better are being offered by the state programs at lower costs with comparison to other alternatives.
Assessing the impact of the 2009 CHIP reauthorization act vetoed this year by the current president
Democrats increased majorities in both Houses of congress in the awake of President Obamas inauguration. Statutory leaders acted quickly to breakage of political deadlock over expansion of SCHIP. On 14th of January 2009, H.R. 2 was passed by the house a 290-138 vote. Spending additional 32.8 was authorized by the bill so as to increase the health coverage program to add approximately additional 4 million children and cover first-time legal immigrants without a waiting period. This increased tax on cigarettes, chewing tobacco as well as other tobacco products to sponsor the expansion of the program. The house bill with two amendments was passed by the Senate on January 29 and the bill was signed into law by President Obama on 4th February 2009. The current President vetoed this reauthorization act because there was a 61 percent increase in federal exercise tax on tobacco products and cigarettes so as to double the federal sponsoring of SCHIP. More so, imposition of increased federal tax can lead to a net-increase in General Fund Revenues (increase in sales tax and reduction in revenues collected) to approximately 9.3 million (Shailagh and Jonathan, 2008)
Review of literature
The Budgetary allocations of CHIP had to conform to the balanced-budget agreement that existed between the White House and Congress. As James and Carney (1997) assert, Pressure to reduce the amount of grants involved was on, with a possible compromise of 16 billion instead 24 was argued by First lady Clinton Hillary. The administration of Clinton had to deal with the leadership of the republicans in Congress that prohibited amendments to be backed to resolutions of the budget. President Clinton inquired from members of the Congress whether Childrens Health Insurance Provision should be demolished. It was so done on May 22 with the amendment of cigarette tax that was necessary being defeated. As per argument of First lady Hillary, the overall budget proposal had to be safeguarded by the President.
Kennedy was angered and surprised as he considered it as a betrayal saying that Vice President Al Gore and President Bill Clinton had not been returned. Kennedy insisted that they shall again and again offer till they prevail. It is of good that children are protected than protecting the tobacco industry. Both Hillary and Bill Clinton suggested that subsequent amendments should include Childrens Health Insurance. Hatch and Kennedy as Michael and Crowley (2004) describe, revived the bill after its defeat and its passage was lobbied by Girl Scout for the USA and Childrens Defence putting pressure on the congress. SCHIP was approved and signed into law by President Bill Clinton on 5th August 1997 as fraction of the Balanced Budget Act of 1997, which had to take effect the subsequent month. Hillary Clinton had given an assistance that was invaluable both in the shaping and the fashioning of the program and acted as a clear advocate.
According to James and Carney (1997), SCHIP is under Title IV caption J of H.R. 2015 (105th) Balanced Budget Act of 1997. Rep John Kasich R-OH initiated and funded H.R. 2015 with no co-sponsors. On 25th June 1997, House Vote Roll241 was passed by H.R. 2015 mainly among partisan lines, 162 nays and 270 ayes, with most Democrats being in opposition. Unanimous consent bill was passed by the Senate in the same day. Passage in both Senate (Roll 209) and House (Roll 209) became more bipartisan (James and Carney, 1997).
Extent of flexibility that individual states have adopted on the eligibility policies and requirements for individuals
SCHIP is in partnership between state governments and federal. Individual states run these programs according to the requirements that set by federal Centres for Medicaid and Medicare Services. Individual states are able to develop their SCHIP programs as programs that are independent and separate from Medicaid (a child health program that is separate), use funds from SCHIP to enlarge their Medicaid program (Medicaid expansion programs in SCHIP), or merge these approaches (combination programs for SCHIP). Enhanced federal funds are received by states for their SCHIP programs at a rate that is above the Medicaid match that is regular.
States had developed SCHIP programs by February 1999, but it needed effort to enrol children. The Clinton administration implemented an Insure Kids Now campaign to enrol more children this campaign was under the Health Resources and Services Administration. As Susan and Milligan (2008) puts it, more than one million children had been enrolled by April 1999, and a goal was set by the Clinton Administration to raise this figure to 2.6 million by the year 2000. Section 42 of Federal-Regulations, Section 457 described regulations that are followed by States with separate child health programs, which have much more flexibility than Medicaid programs as they can utilize an enormous deal of enrolment matters and flexibility in eligibility. The regulations describe the limits to this flexibility, and states like Pennsylvania, North Carolina, Missouri and California ought to describe their qualities of their program in their SCHIP state policies. 43 out of 50 state governors support renewal of SCHIP (Susan and Milligan, 2008). States like California, Pennsylvania, Missouri and North Carolina have integrated usage of private companies to oversee sections of their SCHIP benefits. These Medicaid managed care programs permit health maintenance organizations and insurance firms that are private to deal directly with the Medicaid department of a state at a price that is fixed per enrolee. The health policies then enrol individuals that are eligible into their programs and become liable for guaranteeing that SCHIP benefits are delivered to beneficiaries that are eligible.
In California and Missouri, funds from SCHIP are used to increase eligibility for the states Medicaid programs. Therefore, all Medicaid regulations and rules (including benefits and cost sharing) apply. States like Pennsylvania and North Carolina are permitted to use funds from SCHIP and Medicaid for premium-assistance programs that assists eligible-individuals to purchase health insurance that is private. Few states like North Carolina and Missouri had premium-assistance programs, and had a relatively low enrolment however interest in this approach is still high. Therefore, this rule was not compassionate to those children that could otherwise survive without medical insurance Susan and Milligan (2008).
The impact the changes on health reforms by the federal government assented to by the president in October will have on the administration and effectiveness of the program
The extent to which SCHIP is enrolled as Karen and Massimo (2008) explains is determined by reductions in private coverage. This can assist in assessing the expenditure of the federal government and the overall effects of the program in reducing the number of uninsured children. SCHIP makes private coverage not important for some families and increases the chances of low income families to take jobs that offer higher wages. SCHIP influences employers actions. If employers of low-wage employees accept that SCHIP makes insurance to be of less importance some may reduce their level of benefits offered stop offering insurance and reduce their contributions to the premiums for family coverage. Most employers retort to SCHIP by declining to offer coverage increasing premiums and reducing benefits. This will have a greatest impact on the effectiveness and administration of the program by the federal government.
Discussion
Creation of SCHIP
SCHIP program was implemented with the aim of covering children that are uninsured in families with modest incomes than cannot qualify for Medicaid. SCHIP was created in 1997 and was the largest extensive of taxpayer that sponsored health insurance cover for United States children (James and Carney (1997).
The amendments that have been made on the policy since its adoption
The authority that was legislative for SCHIP is under chapter XXI of the Social Security Act (Phyllis and Schlafly, 1997). During Clintons administration, Senator Hatch Orrin in a partnership with Senator Ted Kennedy and with the help of Rodham Hillary Clinton sponsored SCHIP. Each state was given flexibility in amending its own policies and requirements of SCHIP eligibility within federal guidelines that are broad. Some states got authorities to legislative provision waivers to use the funds from SCHIP to include parents of children that are benefiting from both Medicaid and SCHIP, other adults and pregnant women. During the federal fiscal year 2006, As Phyllis and Schlafly (1997) observed, SCHIP had covered 670 thousand adults and over 6.6 million children and each state had amended its own strategy. During the administration of President Bush, He vetoed two attempts to increase the sponsoring the SCHIP. Childrens Health Reauthorization Act of 2009 was signed on 4th February 2009 by President Obama Barrack, so as to amend the health insurance program to include additional four million pregnant women and children, these also included first-time legal immigrants without a period that is waiting (Shailagh and Jonathan, 2008).
President Bill Clinton proposed a new initiative during his State of the Union Address in 1997, with an objective of covering at most 5 million children. Much of the bill was written by Kennedy using tax paid from tobacco. Republican Senator Hatch Orrin was brought into the statutory by Kennedy to act as a co-sponsor. Hatch commented that, Children are terribly being hurt and perhaps scared for the rest of their lives, and it was the moral-responsibility of the nation to cover them (Phyllis and Schlafly, 1997). The amendment bill was criticized by Republicans as being a prerogative program that is open-ended however it was planned as a block grant but not an entitlement. Senator Lott Trent really opposed the measure terming it as a government program that will not pass.
The administration of Clinton had to deal with the leadership of the republicans in Congress that prohibited amendments to be backed.
The efforts individual states are making to make health care accessible to all children
Individual states are using expansion that is under Medicaid, programs that are separate and a combination of the two approaches. Each state gets an annual allotment for SCHIP basing on an approximation of the target population and an adjustment that reflects costs of medical services. When SCHIP was first designed, the formula for allotment was based on uninsured children that are in families with low-income. Each state spends it own allotment in a period of three years. Unspent funds are redistributed to those states that spent all their funds.
Strength and weakness of CHIP
The main strength of SCHIP Phyllis and Schlafly (1997) observes is that it has a success of insuring children. States can enrol children by increasing their Medicaid program, creating a program that is separate, under SCHIP or designing a combination of the 2 approaches. SCHIP has a weakness of crowding out to use technical terms. Espe and Erik (2007) estimated that 60 percent SCHIP beneficiaries of the government efforts to minimize the number of uninsured are already insured by private firms. Public insurance programs are not effective because their costs are being shifted to taxpayers. For example, SCHIP is prevalent with abuse, waste and fraud. The programs administration is bad as it can cover Viagra for sex offenders serving time. Moreover, the quality of care can be awful, with beneficiaries not being able to either access specialist or have an idea of the number of prescriptions they can receive every year.
Conclusion
Since SCHIP inception, 40 billion has been provided by the congress for it. In 2006, SCHIP enrolled about 6.6 million children as well as 670,000 adults through legislative provisions waivers. SCHIP is not authorized to continue under The United States Current law after 2007, and the Congress considered reauthorization of the program. In 2006, the highest eligibility threshold in a state was 350 percent of their level of poverty and the lowest was 140 percent. Each subsequent year, the federal sponsoring of SCHIP on each state is based on formula that accounts the childrens number in families with low income, the number of uninsured children and each states wages in the health service sector. Unspent funds are re-distributed to states that have exhausted their allotments.
Recommendations
In order to make the Act to be more effective, one can suggest that they should be the option of Modifying SCHIP. Reauthorization gives the congress an opportunity to consider alterations in SCHIP, which include State efforts to enrol uninsured children, Target population should be redefined formula to allocate funds should be changed rules for re-distribution of unspent funds should be modified re-examining SCHIP matching rate and the benefits that states are to provide should be modified.
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