State Children's Health Insurance Program

This report assesses the changes in coverage patterns and health care costs that will occur nationally if major reforms are not enacted. The authors find that by 2015, there could be 59.7 million people uninsured. The number could swell to 67.6 million by 2020, up from an estimated 49.4 million in 2010. As premiums nearly double, employees in small firms would see offers of health insurance almost cut in half, dropping from 41 percent of firms offering insurance in 2010 to 23 percent in 2020. Individual spending could jump 34 percent by 2015 and 79 percent by 2020.

For health reform legislation to maximize coverage among low-income, uninsured Americans, the administrative details for subsidies need to make enrollment and retention simple, seamless, and as automatic as possible for consumers. Neither the House nor the Senate health reform bill extends to Medicaid the streamlined procedures that apply to other subsidies. And with multiple subsidy systems operating under reform, consumers could easily fail to receive coverage for which they qualify. To avoid such difficulties, lawmakers could establish, for all subsidy systems, a single, streamlined system for eligibility determination, enrollment, and retention that minimizes the need for consumers to complete paperwork.

For children currently enrolled in Medicaid and CHIP, the health reform bills in the House and Senate present both potential benefits and risks in terms of the type of coverage these children would have and their access to needed care. This brief estimates the number of children enrolled in Medicaid and CHIP who would have been affected if provisions in pending health reform bills were implemented in 2007. Potential tradeoffs associated with shifting children from CHIP into Medicaid or new exchange plans are discussed.

This brief examines the characteristics of the children who were eligible for Medicaid/CHIP in 2007. The results show that while participation rates were high in both Medicaid and CHIP, some 5 million remained uninsured despite being eligible for coverage. Participation rates, which were found to vary across areas, have likely increased given recent declines in the number of uninsured children. The brief also shows that while interest in public coverage is high among low-income parents, many do not know not know that their child is eligible for Medicaid/CHIP, do not know how to apply, and/or find the application process difficult.

Many past health coverage expansions experienced low participation levels by the uninsured who qualified for help. To avoid similar pitfalls with national health reform, policymakers need to incorporate 21st-century approaches to eligibility determination, enrollment, and retention. One such approach qualifies individuals for subsidies based on reliable data in government hands rather than consumers' completion of traditional application forms. Federal income tax data could thus establish eligibility for subsidies, since more than 6 out of 7 uninsured-86.3 percent—file such returns. Such data-driven eligibility may also lower administrative costs and error rates.