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Welcome to "Ask the White House" -- an online interactive forum where you can submit questions to Administration officials and friends of the White House. Visit the "Ask the White House" archives to read other discussions with White House officials.

Kerry Weems
Acting Administrator Centers for Medicare and Medicaid Services US Department of Health and Human Services

September 28, 2007

Kerry Weems
I’m Kerry Weems, Acting Administrator of the Centers for Medicare and Medicaid Services, the federal agency that oversees the State Children’s Health Insurance Program, generally known as SCHIP.

SCHIP is a critical program in our country —it pays for the health care of more than six and a half million children whose families cannot afford private health insurance, but make too much money to qualify for Medicaid, the federal-state program that provides health insurance for low-income families.

In the 10 years since SCHIP began, states have been using it to make important gains in the health and well-being of low-income and uninsured children. President Bush strongly supports this program (as he did when he was Governor), and has said many times how critical it is to continue the progress the SCHIP program has made. At the same time, however, the Administration believes state efforts should move the neediest kids to the head of the line.

That’s the crux of the issue behind the debate on Capitol Hill around renewing the SCHIP program, and why it’s been in the news so much lately. But I’m afraid there’s been a lot more heat in this debate than light. A number of myths have sprung up about the Administration’s position on SCHIP, and I am looking forward to giving you the facts during this question and answer session.

One thing we all agree on, health care for low-income children is a top priority. I’m looking forward to your questions on SCHIP and thanks for coming in to chat today.

dustin, from sparta, il writes:
what is s-chip?

Kerry Weems
The State Children's Health Insurance Program is a state/federal partnership program enacted with bi-partisan support and signed into law in August 1997. SCHIP is designed to provide health insurance coverage to children in families with incomes too high to qualify for Medicaid in their state, but not high enough to afford private health insurance through their work or in the private market.

SCHIP was originally intended to cover children in families with incomes at or around 200 percent of the federal poverty level or $20,650* for a family of four per year. Some states have exercised their option to increase that amount.

All 50 states and American territories have SCHIP programs in place and currently serve just over six million children.


* $41,300 - Actual level for a family of four per year.

Wesley, from Fort Worth, Texas writes:
How much is health insurance for poor children expected to cost, after one year, after ten years? The government does not have a bottomless pit of money.

Kerry Weems
Investment in the current and future health care of America's low-income children is critical to the future of our nation. Not only is it this great nation's duty to take care of its most vulnerable citizens--low-income children, the elderly and the disabled--it doesn't make economic sense not to.

You are correct that government does not have a bottomless pit of money. However, denying healthcare to those in need only RAISES health care costs in the long run. Children who don't have access to regular, quality health care have more preventable illnesses, miss more school days due to preventable illnesses and have parents who miss work days to stay home with sick kids. Children who are denied routine well baby care can have illnesses that go undiagnosed and untreated until a crisis develops. Not only does the child suffer, but the expense of caring for a medical emergency for a preventable illness is exponentially greater. The question is not whether programs like Medicaid and SCHIP are vitally important to the health and economic future of the nation, that is without question. The issue at hand today is just how much support is the right amount of support for government to provide and how can we encourage the use of private market solutions.

The Bush administration strongly supports the reauthorization of the SCHIP program as well as the continued financial health of Medicaid for all the children in this country who depend upon them. What we want to see, however, is a return the SCHIP program's original goal of covering the lowest income kids first before considering adding other, higher income children.

We will continue to work with Congress to reach an agreement over the future direction of this vital program.

Administrator Weems: I don't understand how we can offer a program that sets health care for people in an income bracket of $72,000-$82,000 thousand dollars. When we have people who make a lot less than this amount and can not afford health care. How in the world does a family of say 4 making the above amounts. Be classified as POOR? I would think this would make 90 percent of all families in the United States POOR and 99 percent of the rest of the world. Thank You

Kerry Weems
The administration does not support providing government-subsidized insurance for families whose income is four times the federal poverty level. The SCHIP program was originally intended to offer health insurance coverage for children in low-income working families who made too much to qualify for Medicaid but not enough to buy private coverage through their jobs or in the private marketplace.

That is the goal of SCHIP and that is the kind of bill the President will sign. We agree that SCHIP should not be extended to higher income children who may have other options for obtaining health insurance coverage.

dave, from Lansing Michigan writes:
It seems like SCHIP will fund activities beneficial to the children of the United States of America. Those health benefits will last for many years, and that the expenditures will recirculate in the domestic economy; whereas expenditures in Iraq, while necessary at this time, may not have as benefical of an effect.Tax increases may be necessary to support SCHIP as well as to pay the war debt. What tax increases per year will be necessary, and what are the BenefitCost ratios of the War and SCHIP. Best Regards.

Kerry Weems
Without doubt, devoting resources to children's health is a crucial social investment that will pay huge dividends into the future. That is why the Bush Administration strongly supports the reauthorization of the State Children's Health Insurance Program. Six million children across America who would not otherwise have access to healthcare are leading better lives because of this program. The administration will continue to work with Congress on a bill that addresses the goal of SCHIP which is to cover children in families with too much income to qualify for Medicaid in their home states, but not enough income to purchase insurance through work or in the private market. That is SCHIP's purpose and that is what this administration is striving to maintain.

Noah, from Sayreville, NJ writes:
President Bush said that the recently approved CHIP bill would take children already being covered by private health care off those roles and put them onto the government program. Isn't the administration aware that, althouogh childre would be protected under this bill, their parents would still have to pay for their health insurance? And seeing that it is a nominal fee (and only a fee that apples to 4-tier health insurance plans, seeing as two-tier plans make no distinction between spouses and spouses plus children) to cover a child (or children) under private plans, people won't drop their health caer coverage if they have it already?

Kerry Weems
Both sides on this issue agree that there will be substitution of federally-financed insurance for private insurance. In addition, both sides agree the higher the family income, the more likely there will be substitution of public insurance for private insurance. We should still try to prevent that from happening, rather than encourage it as would happen under the new legislation. The President believes that poor children without insurance should come first. For instance, New Jersey currently has the highest income coverage in the country at $72,275 for a family of four. Moreover, it spends more than half of its SCHIP funds on adults. Yet, New Jersey remains in the lower tier of states of covering the lowest-income children in their state.

Desiree, from New Jersey writes:
The other day I was reading an article stating that Mr. Bush vetoed the bill for the children's health insurance program. He said it was too costly and many of this children are part of families that are able to afford private coverage. I myself have been under my mother's insurance and i'm about to be cut off because I will be turning 23yrs old, I'm still living at home, working a part- time job and i'm also a full time undergraduate. I'm eligible for COBRA but I can't afford it leaving me without insurance. Now if I can't afford it and my mother makes at least 75,000 a year and I only make min wage and we can't afford it. What makes the administration think that these children that are covered now would be able to get private insurance? Private insurance companies have no sympathy their copayments rise every two years and lets not go on the topic of prescription drugs. Thank you for your time hope to hear from you soon. Desiree Jersey City, New Jersey

Kerry Weems
Thank you for your question. Clearly we need to take steps to help make insurance affordable. The cost of health insurance purchasing it through the individual market in New Jersey is higher compared to other states for a number of reasons including how insurance is regulated in the state. There is a real need for action on the President’s proposals to make insurance more affordable for families and individuals by reforming the tax code and allowing the purchase of insurance across state lines. The bill passed by Congress is likely to make private health insurance even more expensive.

Alicia, from Georgia writes:
My concern about having the states run a program like this is that every state is very different. Those states offering better benefits, will reap the reward of having more low-income earners moving to the state. If the S-Chip is not managed by the federal government, state and local governments will have to raise taxes based on the needs. As a middle-class American, I don't mind paying for those in need, but I want reassurance that I don't have to move to a better financed state to keep from being taxed to death. Thank you for listening to my concern.

Kerry Weems
One of the great strengths of the SCHIP program is the states’ ability to tailor the program to their particular needs. For instance, in a recent report to Congress an important study showed that one of the reasons that SCHIP has been so successful is because of this state flexibility. States have used SCHIP to promote wellness, provide car seats for infants, and dental care. Since SCHIP is a federal-state partnership, states pay roughly 30 percent of the cost of SCHIP.

Pete, from Iowa writes:
Sir: Thank you for taking the time to address our concerns I am concerned about the amount of spending in the federal budget. But I am -more- concerned about the number of children in my state of Iowa who depend upon S-CHIP. I am very concerned that without insurance assistance, our sick kids will be forced into emergency rooms - which we also pay for, but it's more expensive. I would rather pay fewer taxes now for S-CHIP than more taxes later for emergency treatment. I think anyone should agree with that. Do you, and will you help increase our state's share of S-CHIP funds? Thank you. Sincerely, Pete

Kerry Weems
Thanks, Pete. Iowa runs its SCHIP program the way it was originally designed—for children in families making less than $42,000. We strongly support continuing SCHIP for the families in Iowa who rely on “hawk-i.” But some in Congress want to expand the program well into higher income levels and delay needed reforms in the program.

Adding children to SCHIP who already have health insurance does not reduce the number of children without insurance, it simply asks the taxpayers to take up those costs. The bill just passed by Congress has many flaws in it and policies that unnecessarily will drive up costs. And, it will increase the chances that ineligible people will be allowed into the program and it will continue to fund adults in the program. Currently, states are spending $850 million to serve adults and provide government sponsored insurance to those who are already insured.

Talaya, from Maryland writes:
As a taxpayer I would like to know if the S-CHIP bill covers American children only or does it include illegals children as well?

Thank You,

Kerry Weems
Illegal aliens currently are not eligible for SCHIP. The bill coming from Congress does not make them eligible but instead removes important protections designed to prevent people who are not eligible for the program from enrolling in the program. The bill contains “Express Lane” eligibility and performance incentives for the states that would reward them for enrolling individuals who are not eligible. Ineligible individuals include not only illegal aliens, but also high-income individuals and individuals who have insurance.

The President strongly supports reauthorization of SCHIP for the low-income children for whom it was created, and we believe the Congressional leadership needs to work with the Administration and all members of the Congress to restore the important protections in this program and fix the other flaws in this legislation.

Rebecca, from Saint Paul writes:
SCHIP has succeeded in cutting the rate of uninsured children, while the rate of uninsured adults has gone up. But we still have 9 million uninsured kids to cover.

Why do you want to restrict the focus of a successful program, when there is clearly more work left to do?

Kerry Weems
Everyone agrees that SCHIP is a remarkably successful program. President Bush strongly supports its reauthorization. Currently SCHIP serves more than 6 and a half million children and the Medicaid program serves another 30 million children. Since the beginning of the Bush Administration, the number of children served by Medicaid and SCHIP has increased by 8 million. However, the 9 million uninsured children that you have referenced include children who are not eligible for SCHIP because they are in families with higher incomes, they are not eligible because they are not citizens, or they are eligible for Medicaid rather than SCHIP, but not enrolled. According to the Urban Institute, the number of low-income children who were uninsured for a full year and eligible for SCHIP is approximately one million. We believe the success supports our views that SCHIP can be reauthorized with a modest increase in funding, rather than the $35 billion increase under the new legislation. And it’s important to remember, under the legislation, billions of dollars would be spent on individuals who already have insurance or who are not currently eligible for SCHIP.

Kerry Weems
Thank you everyone for some excellent questions, I’m sorry I don’t have time for more. I just want to say again in closing that the Administration strongly supports SCHIP and is committed to its continuation as a strong and successful program. The real discussion is about who gets to be at the head of the line. The Administration believes it should be those children who need it most.

Thanks again, it’s been a pleasure to chat with you.

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