1. National: U.S. Shouldn't Solve Its Debt Problems By Robbing Kids Health Insurance Programs In the discussion about the national debt, the moral imperative of not saddling our children with debt is frequently heralded. It makes perfect sense that the current generation should find ways to manage finances wisely to avoid such a scenario. It also makes sense that we should make investments to provide children with the ability to grow up to be healthy and productive. What doesn't make sense is to rob today's children of the health care they need in order to achieve unrelated goals of balanced budgets-and this is exactly what a debt reduction scheme like the global spending cap would do. This proposal, in fact, would plunder two key health programs: Medicaid which covers 30 million children and CHIP covering an additional 8 million children. Recently, we have witnessed a never-ending array of assaults aimed at health programs that provide the preventive and medical care kids need in their formative years. We've heard a lot about the Ryan plan to change Medicaid to block grants--a move that would endanger the health care of approximately 1 in every 3 children in the United States who receive health care through that program. The major flaw of this proposal is evident: Medicaid block grants merely shift costs to the states, adding a huge burden on the already budget strapped states, or forcing them to cut health care coverage to children. When proposals cut children's health programs, voters make it clear they don't want kids to bear the budget burden now or in the future. According to an April poll commissioned by First Focus, voters by a 2:1 margin disapprove of providing governors with more flexibility if it means eliminating insurance coverage for some children. And a recent Washington Post poll demonstrates that the public overwhelmingly disapproves of cuts to children's health care, as nearly 70% do not support cuts to Medicaid funding. So now that American voters have weighed in, the attempt to cut children's health programs is threatening to come in the backdoor--all dressed up in the ethic of protecting future generations from debt. The untold story about the global spending cap is that it would eventually have the same devastating effect upon children's health as the Ryan budget proposal. Such proposals will not specify turning Medicaid into block grants. They don't have to. It is virtually impossible to make cuts this deep without eventually converting Medicaid to block grants. Budget reduction experts agree that proposals such as a global spending cap can permanently undermine the system of coverage for many children under the guise of “helping” them down the road. Parents, doctors, nurses, teachers and all advocates for children need to rally against these indirect threats as well as those more “front and center.” There are two sets of negotiations creating pressure to pass some form of global spending cap legislation: federal debt reduction proposals and raising the federal debt ceiling--both close at hand. The work is upon us all to educate policy makers about the consequences for children of both the clear and present dangers from proposals like the Ryan budget, as well as the more obscured dismantling of health programs through global spending caps. Make no mistake, these apple-pie sounding deficit proposals can be the backdoor in to decimate essential programs for children's health. Those who truly value the well-being of American's future generations should do all they can to oppose them today. [Kristen Golden Testa, MomsRising.org Blog, 05/25/11] 2. Pennsylvania: Keep The State A Leader in Children's Health Insurance For more than 14 years, the Children's Health Insurance Program (CHIP) has received broad bipartisan support, most likely because Republicans and Democrats see the value in ensuring kids. Providing health insurance is not a political pawn, but simply the right thing to do. Children who have health insurance are more likely to be immunized, receive regular checkups and get prompt treatment for common childhood ailments such as ear infections and asthma. Children who have health insurance generally have uninterrupted school attendance and better school performance. Without a doubt, CHIP has proved to be a cost-effective way to cover our youngest residents and has significantly reduced the number of uninsured children, especially low-income children, across the country and here in Pennsylvania. But now, legislation has been introduced in the House and the Senate to repeal stability protections (known as “Maintenance of Effort”) that were part of the Affordable Care Act signed into law in March 2010. The State Flexibility Act would repeal a provision of federal health reform law that requires states to maintain current eligibility and enrollment requirements for Medicaid and CHIP. The sole purpose of the State Flexibility Act is to give states permission to eliminate health insurance for vulnerable Americans, including low-income children. Without the “Maintenance of Effort,” an estimated 200,000 children covered by Medicaid or CHIP could be dropped from coverage, including more than 14,000 children in central Pennsylvania. As someone who has devoted my career to caring for children, it is unfathomable to me that our elected officials would trade the health and well-being of children for politics, and, worst of all, from families who can least afford it. The nonpartisan Congressional Budget Office estimates that if this proposed legislation becomes law, half of states will eliminate their CHIP programs by 2016 while the remaining states will scale back health insurance for children-resulting in hundreds of thousands of newly uninsured children-and unraveling the success the nation has seen in bringing the rate of uninsured children to the lowest point in decades. In Pennsylvania, the stability protections have helped preserve CHIP and have maintained a crucial lifeline to children and families during tough economic times. Health insurance is a vital link between children and a successful future. Because I devote my time to caring for children in a community-based setting, I have seen firsthand children who have gone too long without seeing a doctor, kids whose parents didn't have health insurance and worried about how to pay the doctor's bill. Without health insurance, children are more likely to suffer with undiagnosed and untreated conditions that have the potential to become much more serious issues. Furthermore, uninsured children are more likely to miss school and have diminished academic achievement. Children need health insurance to get a good start in life. And we've made great strides in Pennsylvania covering kids and helping them thrive. Why would we want to go backward? It is misguided to reverse the progress made on children's health care. I urge our leaders in Washington to protect children's health insurance by rejecting the ill-advised State Flexibility Act. [Allen Nussbaum, Patriot News, 06/28/11] 3. National: Despite Gains in Children's Health Insurance, Political Challenges Remain The number of children without health insurance has dropped significantly in recent years, but political challenges in Congress and implementation missteps under the health reform law by the states and federal government could erode these gains, health policy analysts at the Urban Institute said. The number of children 18 and younger who are eligible but not enrolled in Medicaid or the Children's Health Insurance Program (CHIP) dropped by about 1.1 million between 2007 and 2009, said Genevieve Kenney, a senior fellow at the Urban Institute. This leaves about 4.5 million children eligible for health insurance but not enrolled in either program. Between 2008 and 2009, national enrollment of children in Medicaid and CHIP increased from 82 percent to 84.7 percent among eligible children, Kenney said, adding, "That's a pretty substantial increase in a one-year period." Although the gains were disproportionately in northeastern states, all states saw increases in enrollment of children in Medicaid and CHIP, including Western and Southern states that historically have had lower enrollment, Kenney said. One factor driving these enrollment increases is the CHIP Reauthorization Act of 2009, she said. That gave states funding for enhanced outreach and enrollment efforts in addition to "bonus grants" for states that adopted certain enrollment and retention strategies. Despite this progress, more than two-thirds of uninsured children are eligible for Medicaid or CHIP but not enrolled, Kenney said. The largest number of uninsured children reside in California, Florida, and Texas. Although California has a participation rate close to the national average--about 85 percent--Florida and Texas have participation rates below 80 percent, Kenney said. Political Challenges in Congress. Moreover, efforts by Republican lawmakers in Congress to roll back certain provisions of the Patient Protection and Affordable Care Act (PPACA) have the potential to erode coverage gains among children, Kenney said. In particular, she cited legislation to repeal maintenance-of-effort requirements under Medicaid and CHIP. The MOE requirements, which were enacted as part of PPACA, prohibit states from imposing stiffer eligibility standards for enrollees under Medicaid or CHIP in return for an enhanced federal match rate. "To the extent that provision is overturned, it could lead to less coverage if states cut back," Kenney said. "Even more critical," Kenney warned, are efforts to transform Medicaid--currently a program funded jointly by states and the federal government--into a block grant program in which the federal government would send states a set amount for Medicaid each year. House Republicans proposed a block grant program for Medicaid in their budget plan for fiscal year 2012. Urban Institute research has concluded that implementation of a block grant program for Medicaid would reduce enrollment in the program by 41 percent to 58 percent, she said, adding, "That absolutely has potential to be game-changer in terms of coverage for kids and parents." States Face Implementation Challenges. Stan Dorn, Urban Institute senior health analyst, echoed Kenny's guarded optimism about the sustainability of increases in children's health insurance. He said the increases in coverage among children were "extraordinary" but warned of "premature celebration." He cited challenges facing states as they implement a significant expansion of Medicaid mandated by PPACA, which is expected to cover about 16 million new enrollees beginning in 2014. Noting that computer systems used by states in their Medicaid programs "date from the 1970s," Dorn said states will need to quickly upgrade those systems to handle eligibility determinations for the new enrollees. Most of the new enrollees for Medicaid and CHIP will apply for health insurance through the new, state-based health insurance exchanges, he said, adding that PPACA provides states with additional funding to cover some of the system upgrades that will be required. Another challenge will be the "culture and business practices" within the social services offices responsible for handling the increased Medicaid and CHIP coverage, Dorn said. In many states, caseworkers are in the habit of requesting types of documentation for eligibility under Medicaid and CHIP that no longer will be required, he said. "Complex Coverage Scenarios" Need Attention. Stacey McMorrow, a research associate at the Urban Institute, cited other implementation challenges under PPACA that could impact health coverage for children. These include how states and the federal government address "complex coverage scenarios" affecting two specific categories of children, she said. They are: children who are eligible for Medicaid or CHIP while their parents are not eligible and children who live with only one or neither of their parents. The first group will require special outreach efforts to ensure these children obtain coverage, McMorrow said. In determining health insurance eligibility for the second group, states must adapt quickly to new health insurance rules that are different from traditional child support requirements, she said. [Ralph Lindeman, Bureau of National Affairs, 06/08/11]