Say Ahhh!

Today, there's a new beat coming out of Nashville, Tennessee (aka Music City, USA).  Tennessee Governor Phil Bredesen has changed his tune and announced that on March 1 enrollment will resume for CoverKids, the state's Children's Health Insurance Program (CHIP).  The Governor had frozen enrollment in November but, after a loud public outcry, he decided to tap a state savings account for public health programs to re-open enrollment for uninsured children.

The news is music to the ears of the parents of the 145,000 uninsured children in Tennessee who may be eligible for coverage if they are unable to find private health insurance.  The Tennessee Justice Center and other advocates have been urging the Governor to re-open enrollment.  Michele Johnson at the Justice Center blogged about the enrollment freeze on Say Ahhh! last month and credits the blog with helping to focus attention on the issue which led to the Governor's action to re-open CoverKids. 

In announcing the change in policy last night, the Governor was quoted as saying: "Fortunately, we've been able to dig deep and find additional funding to keep this option available to families in need."

Let's hope other Governors and state policymakers are paying attention and will "dig deep" before denying access to affordable coverage to children in need.

Donna Cohen Ross

Outreach Director, Center on Budget and Policy Priorities

One year ago last Thursday, President Obama signed the Children's Health Insurance Program Reauthorization Act (CHIPRA) into law.  The President's words that day reinvigorated a nationwide effort to ensure that children have the health coverage they need.

We have made significant strides since then, as CMS details in a new report. Despite grim budget conditions, states have expanded coverage, streamlined enrollment procedures, and stepped up outreach efforts.  And, when the weak economy generated increased need, Medicaid and CHIP rose to the challenge, covering 2.6 million previously uninsured children last year.

My memory of last year's bill-signing got me thinking about two incredible people who exemplify the challenge that lies before us:  Greg Secrest and Ann Walker, both from Martinsville, a once-robust manufacturing town in southern Virginia.  Greg used to work for a furniture manufacturer, but was laid off when the company moved overseas.  Without health insurance or a job, Greg found help at Project Connect (a program funded by the Virginia Health Care Foundation and Anthem Blue Cross Blue Shield Foundation), where Ann, an outreach advocate, helped dispel his skepticism about CHIP and signed up his two sons. 

Invited to the White House CHIPRA signing ceremony last year, the entire Secrest family traveled to Washington to join the President and other distinguished guests.  President Obama mentioned the Secrest family in his remarks saying:  "Let's give Americans the support they need to weather this crisis... In the end, that's really all that folks like the Secrests are looking for -- the chance to work hard and to have that hard work translate into a good life for their kids." 

I called Ann and Greg last week for an update. Ann is still working hard to help unemployed families find the help they need.  "Anywhere there's a door," says Ann, "I'm still sticking my toe in. I'm a nagger.  I'm a stalker." 

Greg gives Ann high praise: "If I could give Ms. Walker a medal, I would. She gave me peace of mind.  Because of her, I have health insurance for my children and I don't have to worry when my kids go out to play."  That had been a motivating force -- Greg's 16-year-old had wanted to play football and join ROTC, but his parents worried about what would happen if he got injured and didn't have health insurance.

Martinsville has the state's highest unemployment rate, at over 20 percent. With many more companies downsizing or shutting their doors, Ann keeps sticking her toes in where she has to -- Stanley Furniture, Stuart Flooring, CP Films, even Food Lion.  She has been invited by the local Virginia Employment Commission to be a part of the "rapid response team" that visits firms laying off workers to give them swift access to information about applying for available benefits.  As Ann points out, the VEC visit may be her first, but it's rarely her last.  It may take awhile to reassure parents that Medicaid and CHIP aren't "handouts" -- they were designed to help people get through tough times like these. 

Greg Secrest is now a full-time community college student with his eye on a business degree.  His wife, Rileen, found a part-time job keeping the books for a biodiesel company.  CHIP coverage has helped enormously.  During the year, a football injury sent one son to the doctor.  Sinus medicine for the other would have set the family back $50 or $60 if it hadn't been for insurance.  The Secrests have renewed CHIP coverage for their boys, although they needed Ann once again to troubleshoot when the paperwork they submitted got lost. 

To build on last year's progress, on CHIPRA's anniversary, Secretary Sebelius issued a new challenge: Cover the remaining 5 million uninsured children who are eligible for Medicaid and CHIP in the next five years.  To do that, we'll need many more Ann Walkers, with their unrelenting spirit and willingness to stick their toes in lots of doors -- but they're going to need more help from us as well.  We need to redouble our efforts to reduce the paperwork barriers that keep eligible children from getting and keeping coverage.  We need to acknowledge, as Secretary Sebelius did, that Recovery Act funds have been instrumental in bolstering state finances and protecting Medicaid from cuts.  Convincing Congress to renew that support is absolutely critical.  

Finally, we can't forget that it's not just children who need coverage. Greg Secrest didn't mince words when he said, "We as a country need good health reform."  Despite his family's trials, Greg remains an optimist.  "There's a light at the end of the tunnel; we just have to go a little further to see it. It will get better.  I want my kids to know that." 

As we ended our phone call, Greg said he especially wanted to thank everyone who worked for health coverage.  I just want to thank Ann and Greg for sharing their stories of perseverance with all of us.  

The views expressed by Guest Bloggers do not necessarily reflect the views of the Center for Children and Families.

(Editor's Note:  Ann Walker is pictured above helping families access affordable health coverage for their children.  She is one of the many hard-working outreach workers helping families secure coverage for their uninsured children.)   

In many cultures, the first birthday of a child is a major community celebration.  It signifies that the baby has made it through the critical first year and is now destined for great things.  

We should be celebrating the first year of the Children's Health Insurance Reauthorization Act (CHIPRA).  CHIPRA renewed the Children's Health Insurance Program (CHIP) and gave states new tools and fiscal incentives to enroll more uninsured children in CHIP and its larger companion program, Medicaid.  Unfortunately, for many of us, it just doesn't seem right to have a big celebration when there is so much uncertainty over the future of health reform.  I confess that I was reluctant to celebrate CHIPRA but when I thought about how the past year would have been without it, I came to my senses.  Without CHIPRA and the temporary increase in federal funding for Medicaid included in the economic stimulus package, the health needs of so many more children would have gone unmet. 

In the past year, while private insurance has become less available and more expensive and families faced the most difficult economic times since the Great Depression, the renewed CHIP program and Medicaid have offered a vital lifeline to America's children.  Thanks to the strong resolve of national and state leaders, many of our children have been sheltered from this economic storm.  

CHIPRA, and the increased funding for Medicaid, helped states strengthen and maintain their commitment to children's health coverage just when they needed it most.  While the financial investment was relatively small, it made a huge difference in the lives of the people it helped.  Just ask the Simpson family from Benton Arkansas who were able to maintain CHIP coverage for their children when Mr. Simpson lost his job as an electrician. 

This is but one example of the lives touched by the positive actions of national and state leaders to sustain and strengthen children's health coverage over the past year.  Families with children who had asthma, diabetes or autism who couldn't afford private insurance had access to health coverage so they could get their children the treatment and preventive care so crucial to their well-being.  Parents who lost their jobs and health insurance were able to turn to CHIP or Medicaid to secure coverage for their children.  (It would be better for the entire family if the parents also had access to stable, affordable health coverage that didn't disappear when they lost their jobs but we'll have to wait for broader health reform to make that improvement to the health care system.) 

CHIPRA was not intended to solve all of the gaps in our health care system but was designed as a bridge until our nation's leaders were able to pass broader health reform.  While the timing of health reform is uncertain, one fact remains clear - children and families need access to secure, stable, affordable health coverage that won't be taken away if they lose a job or become sick. 

So what should we give CHIPRA on her first birthday?  How about a sibling named Health Reform?

While there hasn't been much good news coming out of Washington lately on the health care front, the President's newly released FY 2011 budget offers some positive developments.

Most notably, the budget proposes $25.5 billion to extend the temporary FMAP increase for another six months, through June 2011. The FMAP increase and its accompanying maintenance of effort provision, which was included in last year's stimulus bill (ARRA), has been an incredibly important way to help states maintain their Medicaid programs during an economic downturn. Set to expire at the end of the calendar year (which is right in the middle of states' fiscal year), the Administration's proposed extension would provide critical relief to cash-strapped states. Since the budget extends the recovery act provision, states would still need to maintain Medicaid eligibility and enrollment/renewal procedures to receive the increased FMAP.

The budget also assumes savings from health reform, signifying the President's continued commitment to passing a bill. Using the average of the savings estimated under the House and Senate bills, the budget projects roughly $150 billion in savings over 10 years. 

The budget also proposes:

 * Extending, through the end of 2010, the COBRA health insurance premium assistance program established under the recovery act (set to expire at the end of this month).

* Providing an additional $290 million for community health care centers, $110 million for continuing investments in health IT, and an increase of $250 million for Medicare, Medicaid, and CHIP fraud and abuse initiatives.

* Allocating funding to strengthen rural health care, expand Indian health services, increase wellness and prevention activities, and conduct research on the comparative effectiveness of medical options.

* Establishing Medicaid and Medicare demonstration projects to coordinate care and lower costs for seniors and those with chronic conditions.

Also of note is a 229% increase in state Medicaid performance bonus payments. This change reflects the Administration's expectation that states will continue to enroll more children in Medicaid, resulting in an increase from $73 million in FY 2010 to $240 million in FY 2011 in payments made to states.

The President proposed a couple of measures that could impact programs for low-income families moving forward. This includes a 3-year non-security discretionary spending freeze (although Medicaid, CHIP, and most health programs were excluded) and the creation of a bi-partisan fiscal committee, which is charged with, among other things, addressing the growth of entitlement spending.

Expect to hear more from us in the coming months as Congress begins its work to have a final budget signed by the President by October 1.