Term Paper on "State Children's Health Insurance Plan"

Term Paper 30 pages (8370 words) Sources: 15 Style: APA

[EXCERPT] . . . .

Children's Health Insurance Plans

Regardless of one's political affiliation, it is hard to deny the fact that America is currently experiencing a tremendous healthcare crisis. Many Americans simply cannot afford private health insurance even when they have access to reduced-cost benefits through employers, and a growing number of employers are choosing not to offer health insurance benefits, at all, because of the exorbitant costs. For those who can obtain insurance through their employers, the costs can be prohibitive and the insurance provided may not provide significant everyday healthcare savings, even if it can make a dramatic difference in cases of serious illness or medical emergencies. This health crisis impacts the working lower class and the true middle class disproportionately because they oftentimes make too much money to qualify for Medicaid, but cannot access other forms of health insurance or afford the costs associated with regular and emergency health care. One reason that the lower class and the working middle class cannot access health insurance is because many hourly employers do not offer benefits to part-time employees, and some employers even have policies limiting hours for the majority of their employees, to avoid paying insurance and providing other benefits. Even when policies are offered, they are frequently only partially-sponsored by the employer, and the employee can be responsible for hundreds of dollars each month in insurance payments, which can consume the majority of a working-class paycheck. The result is that many Americans do not have health insurance, and because of that, they may also be denied access to routine health care, treatment for chronic illnesses, and treatment for minor emergencies.

Even more alarming is the fact that many of those who are uninsured are children. The impact of not having health insurance can be devastating on any person. The correlation between being uninsured and having a poorer standard of health is clearly established. However, children are disproportionately impacted by not having health insurance. This is because children without health insurance are frequently children who do not receive adequate medical care. Some doctor's offices and lower-level emergency care centers refuse to see patients without insurance, or insist upon up-front payments, which can be prohibitively expensive for people in lower income brackets, especially if the medical attention sought is unplanned or if a child has a chronic health condition. In fact, health insurance is important for children, including teenagers, for several reasons:

Children who have health insurance generally have better health throughout their childhood and into their teens. They are more likely to: receive needed shots that prevent disease; get treatment for recurring illnesses such as ear infections and asthma; get preventative care to keep them well; get sick less often; and get the treatment they need when they are sick." (U.S. Department of Health and Human Services, 2008).

While children without health insurance do have some access to medical care, they do not have access to the same type of reliable health care as insured children. For example, parents whose children are insured can pick one doctor and take the child to visit the same doctor for sick visits and well checks, rather than relying on emergency clinics and emergency rooms for sick visits. In addition, a lack of insurance benefits can mean that children may not be able to obtain prescription drugs.

Furthermore, a lack of health insurance impacts far more than a child's physical health. Good physical health has an impact on quality of life that goes beyond issues of sickness and health. For example:

Having health insurance will allow you to give them the medical care necessary for them to stay healthy and focus on their studies. Children with health insurance are less likely to miss school because they are sick. By helping them go to school every day ready to learn, [one] can help boost [a] child's performance in school today and in the future." (U.S. Department of Health and Human Services, 2008).

Obviously, the fact that so many children lacked health insurance, and therefore lacked access to health care, was a tremendous health care crisis. To help ease this crises, in "1997 Congress passed legislation that allows states to provide health insurance to more children in working families." (U.S. Department of Health and Human Services, 2008). S-CHIP was "created as part of the Balanced Budget Act of 1997 (BBA-97; P.L. 105-33) and enacted as Title XXI of the Social Security Act. In the act, Congress allocated over $40 billion for SCHIP through 2007, making it the largest federal expansion of health insurance coverage since the passage of Medicaid in 1965." (National Conference of State Legislatures Forum for State Health Policy Leadership, 2007).

Though the program is not Medicaid, "these programs build on the Medicaid program that started covering children and adults in the mid-1960." (U.S. Department of Health and Human Services, 2008). Therefore, the programs are funded by a combination of state and federal tax dollars. Like Medicaid, the programs are operated individually by each state, but with federal oversight and according to federally-set rules and regulations. As a result, the individual details about each program vary from state to state. However, there are some constants in the state programs. First, there are no time limits to the S-CHIP programs. A "child can stay on the program as long as he or she qualifies." (U.S. Department of Health and Human Services, 2008). However, parents need to renew their coverage periodically; usually every six to twelve months. Eligibility rules vary from state to state, "but in most states, uninsured children 18 years old and younger whose families earn up to $34,100 a year (for a family of four) are eligible." (U.S. Department of Health and Human Services, 2008). Some states expand the qualification range, permitting families with higher incomes to access the services. The cost for the S-CHIP program varies from state to state, and possibly according to income, but they are generally low-cost or free, and co-payments, if any, are low. Some states make payments contingent upon income, and use a sliding-scale to determine the payments for each individual family. However, children who are eligible for Medicaid are not eligible for S-CHIP, because they already have access to total health coverage.

States are able to structure their S-CHIP programs in three main ways. First, states can opt to expand their current Medicaid coverage, by covering "older children or children from families with incomes too high for them to qualify for regular Medicaid. In Medicaid expansion plans, all Medicaid rules apply. Medicaid's restrictions on cost sharing apply, and the state may not cap enrollment (turn away applicants who are eligible) after a certain number of children have enrolled or after the state has exhausted its funds. The state receives federal reimbursement for expenses at its regular Medicaid 'match rate.'" (National Conference of State Legislatures Forum for State Health Policy Leadership, 2007).

Next, states can design their own plans by creating:

An entirely new program with a benefit package consistent with provisions of Title XXI...In state-designed SCHIP programs, service delivery, quality assurance mechanisms, enrollment procedures, benefits and even the name of the program may be different from those of Medicaid. State-designed programs must be approved by the secretary of the Department of Health and Human Services. States have several benefit package options. (National Conference of State Legislatures Forum for State Health Policy Leadership, 2007).

States can choose benchmark coverage, which is equivalent to federal or state employee coverage or the package offered by the states largest non-Medicaid HMO coverage.

They can create benchmark equivalent coverage, which means that benefits have to have the same actuarial value as one of the benchmark benefit packages. States can also choose to implement existing state-based comprehensive coverage, which means that their benefits have to equivalent to similar non-Medicaid programs that existed before S-CHIP.

Finally, states can choose combination plans, which expand Medicaid and create a private plan for different populations. These combination plans are not required to accept all of the enrollees, and the states are required to use their own funds to help people after spending their full S-CHIP allotment. The combination plans give states the greatest autonomy, but also require states to exercise more oversight and spend a greater percentage of state funds than federal funds.

Of course, states are not required to use S-CHIP. The program is opt-in and requires active state participation. Furthermore, states are required to use some of their own funds to run and fund individual S-CHIP programs. The overwhelming majority of states have chosen to do so. However, Tennessee does not have an S-CHIP program.

One of the interesting facets about S-CHIP is that it was created to fill the gap between Medicaid and those who can afford insurance, not to address health care in the impoverished population. Therefore, it should come as no surprise that different states have set different income levels for people to qualify, because different states have different costs of living. "Twenty-five states and the District of Columbia have income… READ MORE

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