State aims to expand ARKids
Posted on Sunday, August 12, 2007
Arkansas is trying to sign up more adults for health coverage through the State Children’s Health Insurance Program, just as funding for the federal subsidy is up for debate in Washington.
President Bush has threatened to veto legislation that he thinks expands the federal program too much, but Arkansas needs funding increases in part to keep up with new coverage for the uninsured that state officials are heavily promoting.
“The state would be in a bind” if funding stays flat, said Julie Munsell, spokesman for the state Department of Human Services.
ARKids First, which provides health care for children in lowincome families, is the biggest state program funded by the federal subsidy.
But Arkansas is also one of only 15 states authorized to provide coverage to adults through the program originally intended for children.
After working for five years to get federal approval, the state last year started ARHealthNet, which is designed to extend health coverage to workers at small businesses that don’t offer insurance plans.
ARHealthNet began enrolling people in January. Participation has risen in recent weeks after Gov. Mike Beebe toured the state touting the program.
So far, 878 people have signed up, and the state expects that number to grow to 1, 300 by the end of the year.
The new program is administered through small businesses that have not offered healthcare coverage for at least a year. It’s not entirely funded by the State Children’s Health Insurance Program, but employees with children who are eligible for ARKids can have their premiums subsidized through the federal program.
As Beebe and others seek new enrollees, Congress is working to keep funding for the program past its Sept. 30 expiration date and to expand coverage.
Senate and House bills passed earlier this month. The Senate version would increase the cost of the program nationally over five years to $ 60 billion, the House version to $ 75 billion, mostly by more than doubling federal tobacco taxes.
If funding remained flat, the program would cost $ 25 billion over five years. About 6 million children are insured through various State Children’s Health Insurance Programs today, and the competing bills would pay for an estimated 3 million to 4 million more children.
“It should be a priority for our country,” said U. S. Sen. Blanche Lincoln, an Arkansas Democrat who serves on the Finance Committee that drew up the Senate plan. “It reflects our values and our morals, getting as many children into a health insurance program as we can.” Congressional negotiators will try to come up with a compromise package next month, but Bush has said both bills are unacceptable. He wants to limit the program to $ 30 billion over five years.
The Kaiser Commission on Medicaid and the Uninsured estimates that $ 39 billion would be needed over the next five years just to maintain current coverage.
States offer an array of programs funded through the State Children’s Health Insurance Program and share the costs with the federal government. Arkansas offers three, the oldest of which is ARKids First.
It offers health coverage to children whose families make up to 200 percent of the poverty level. That’s about $ 41, 300 a year. The program began in 1997, but at the time was funded by Medicaid.
In 2003, Arkansas won approval to use the State Children’s Health Insurance Program as the federal funding source. That saved the state money because the federal government pays a bigger share for Arkansas’ programs than for those funded through Medicaid.
Since ARKids First began, the percentage of uninsured children in Arkansas has dropped from 23 percent to 10 percent. More than 77, 000 children are enrolled, but the state estimates that 101, 978 are eligible.
There’s been debate in Congress about whether adults should be phased out of the State Children’s Health Insurance Program.
Beebe said in a recent column that his administration believes the program should pay to insure the parents of ARKids children.
Dr. Joe Thompson, the state’s surgeon general, helped design the ARHealthNet program, the idea for which grew out of a health-care round-table he led. It makes sense for the parents of ARKids-eligible children to be covered, he said.
“There’s pretty good evidence that a kid is more likely to be enrolled in the SCHIP program if the parent has health insurance,” he said.
U. S. Rep. John Boozman, a Republican who represents the state’s 3 rd District, was the only member of the Arkansas congressional delegation to vote against the program’s renewal. He said in an interview that he supports reauthorization and the programs the state offers, though he said he’s generally uncomfortable with using program funding to expand health-care coverage for adults.
Boozman said his vote was an expression of his disagreement with aspects of the Housepassed plan.
For example, it shifts money from certain Medicare programs including the managed-care Medicare Advantage, as well as increasing the federal tobacco tax by 45 cents per pack of cigarettes.
“I’m very much in favor of expanding the SCHIP program, but I don’t think we can do that on the back of Medicare,” Boozman said.
The Senate version doesn’t touch Medicare but would increase tobacco taxes by 61 cents per pack.
Like Bush, Boozman objects to the idea of allowing states to provide coverage to people in families who make four times the federal poverty level, or over $ 80, 000 a year. Arkansas doesn’t allow that, but states have flexibility and several have higher income guidelines.
Boozman said he agrees with Bush that the higher income eligibility would encourage families to drop their private insurance in favor of a cheaper government program.
Munsell said Arkansas’ plan was specifically designed to discourage that. The safeguard is that businesses may not participate in ARHealthNet unless they’ve offered no health insurance for a year or more.
The state argued for a federal waiver to allow adult coverage by arguing that it would be costeffective in the long run.
“The theory is that by providing these preventive services on the other end of the scale, you’re lessening the amount of uncompensated care,” Munsell said.
The third program Arkansas administers through the State Children’s Health Insurance Program is for pregnant immigrant women, including illegal aliens. It’s sometimes referred to as the “unborn child” program.
Offered in Arkansas since 2004, the program is designed to cover prenatal care for women who otherwise wouldn’t be eligible for Medicaid. In the face of questions about whether the government should pay medical costs for women who may be illegal aliens, former Gov. Mike Huckabee defended the program as “pro-life” because its intent is to provide care for a child who will be born a U. S. citizen.
The program covered 3, 652 women in the fiscal year that ended in June.
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