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By Dr. Stephen Berman, Susan Molina and Megan Ferland

Colorado voters want the federal and state government to address the problem of uninsured children. In a Mason Dixon poll commissioned by the American Academy of Pediatrics before the last election, 73 percent of voters responded that every child in Colorado should be covered by a government-supported health-care program if their parents are unable to afford insurance. The likelihood that Colorado will be able to develop a financially feasible plan for every Colorado child to have health insurance will depend on how Congress reauthorizes the State Children’s Health Insurance Program (SCHIP) this session.

This program provides 65 percent of the funding for the Colorado Child Health Plan Plus, which enrolled almost 60,000 children and adolescents under 19 years of age during 2005. SCHIP was passed by Congress in the Balanced Budget Act of 1997 during the Clinton presidency. The legislation appropriated about $40 billion for 10 years, 1998 through 2007. In 2007, SCHIP must be reauthorized by Congress with a new appropriation of funds in order to continue to function in 2008.

For fiscal years 1998 through 2001, the annual appropriation was slightly over $4.2 billion. The appropriation dropped to less than $3.2 billion from 2002 through 2004, but then increased to $4.1 billion for 2005 and 2006 and $5.0 billion in 2007.

However, the original budgeting approach leaves future funding vulnerable because significant additional funds over the 2007 allocation — between $12 billion and $15 billion — will be needed during the next five years just to allow states to maintain their existing SCHIP programs. Expanding existing state programs will require funds in addition to the $12 billion to $15 billion.

While it seems certain that SCHIP will be reauthorized because of its broad base of congressional support among both Republicans and Democrats, it is less clear how much new funding will be appropriated and whether any changes will be made to promote enrollment, improve quality of care, and facilitate further expansions in coverage. Therefore, how Congress reauthorizes SCHIP will become a “tipping point” for states trying to reduce the number of uninsured children and adults.

According to the Kaiser Commission on Medicaid and the Uninsured, a reauthorization that only maintains the 2007 allocation — as is proposed in President Bush’s budget sent to Congress last week — will mean that states will have to implement SCHIP enrollment caps and 1.5 million children will be dropped from their programs by the fifth year. This would prevent Colorado from increasing its SCHIP eligibility higher than 200 percent of the poverty level and enrolling more uninsured pregnant women. As a result, substantially more state and private dollars will be necessary to cover the uninsured in Colorado.

Alternatively, if funding for SCHIP is expanded, this federal–state partnership can provide a strong foundation for further state-based initiatives to cover the uninsured, starting with children.

Expanded federal funding should create a financial incentive for states to enroll a higher percentage of their eligible children. This would encourage states to improve their outreach and marketing and implement more streamlined enrollment procedures. Modifying or waiving the onerous citizenship verification requirements would also assist states in streamlining the enrollment process.

There are also several incremental options for expanding coverage with SCHIP to reduce the number of uninsured children. The reauthorization could increase the age of eligibility, since 19-25 year olds have the highest rates of being uninsured. It could give states the option to cover legal immigrant children during their first five years living in the country and the option to cover uninsured pregnant women during their prenatal, delivery and post-partum periods. The reauthorization could also make it easier for states to use SCHIP funds to help families purchase family employer-sponsored insurance coverage and to help small employers pay for employee children who are enrolled in Medicaid or SCHIP.

Congress has indicated that the funding for an expansion of an existing program or new program must be offset by a reduction in spending from another existing program because of the nation’s budget deficit and ongoing Iraq war. While federal fiscal discipline is important, the health of Colorado’s and our nation’s children should have a higher priority.

Dr. Stephen Berman is the past president of the American Academy of Pediatrics. Susan Molina is the chairperson of the Metro Organizations for People. Megan Ferland is the president of the Colorado Children’s Campaign.

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