COST: Making Sure the Kids Are All Right

Joanne Kenen — Fri, 02 May 2008 19:53:00 -0400

First Focus, a children's advocacy group, this week in its Children's Budget 2008 reported that only one cent of each "new" dollar of federal spending (excluding defense) goes to kids. A lot of the report focused on education, so we asked them how does health spending add up. The answer: not so hot.

The overall share of federal, non-defense spending going to children's programs has dropped by 10 percent over the past five years. Real discretionary spending on children has declined by more than 6 percent since 2004, while at the same time all other non-defense discretionary spending has increased by more than 8 percent, the group reported.

Because so much of spending on children' health is through Medicaid, SCHIP, and other entitlements, not out of the discretionary budget, spending on health programs did grow from 2004–08. However, total spending on children's health amounts to less than 2 percent of the total federal budget, and less than 0.4 percent of the Gross Domestic Product.

Outside the mandatory programs, discretionary spending on children's health has declined in real terms. Discretionary spending is down 6.3 percent. As a share of total federal spending, children's health spending has lost ground. Children's health spending currently makes up 1.9 percent of all federal spending, while in 2004 its share was 1.97 percent, a 3.5 percent drop.

In addition, the $35 billion SCHIP proposal, which President Bush vetoed, represented one-quarter of 1 percent of the federal budget.

We believe that the entire health system needs to be overhauled for both equity and efficiency, which includes looking comprehensively at our kids' health and how we spend federal dollars. But these trends concern us. Investing in children means investing in their health and wellness. It will pay off in countless ways. Short term budget fights and long-term reform efforts have to make sure that, as this group's name implies, we first focus on what really matters.

IN THE STATES: Iowa Seeks Ways of Covering Kids

Joanne Kenen — Thu, 13 Mar 2008 19:24:00 -0400

Iowa this week took a big bipartisan step toward covering uninsured low-income kids, but without yet settling the question of how to pay for it. The Bush Administration last year vetoed bipartisan legislation aimed at expanding SCHIP (the State Children's Health Insurance Program) and issued regulations that make it harder for states to broaden SCHIP eligibility on their own. Slightly more than nine million of the nation's 47 million uninsured are children, and two-thirds of the children are eligible for either SCHIP or Medicaid, according to the Kaiser Family Foundation.

Still with a striking 97-0 vote, Iowa's House showed a commendable commitment to covering all kids by 2011. The state has also set a goal of covering kids and adults alike by 2013. The state House bill, similar but not identical to legislation that has passed the state Senate, would cost $30.8 million a year when fully implemented, according to the Des Moines Register.

About 25,000 of the estimated 44,000 children without health insurance qualify for HAWK-I, the local SCHIP program for low-income families, according to the newspaper.

The rub, however, is money. States that want to expand SCHIP have run into roadblocks because of a regulation issues last summer that makes it harder for states to expand coverage. Before raising eligibliby to 250 percent of the federal poverty level, states must enroll 95 percent of the eligible poorer children (200 percent FPL), a standard which many state children's health directors say is unrealistic.