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Universal Coverage, Health Inequalities, and the American Health Care System in Crisis (Again)
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| | Unformatted Document Text:
APSA 2004
U
NIVERSAL
C
OVERAGE
19
“Perfect Storm” currently battering Medicaid: growing demand for the program, increasing medical inflation, and declining government revenues.
118
Figure 4
The SCHIP Dip: Enrollment and Federal Funding (Projected), 1998-2007
6
5
4
Enrollmen
t
(millions)
3
Funding
2
1
0
1998
1999
2000
2003
2004
2005
2006
2007
2001
2002
Year
($ billions)
Source: C
INDY
M
ANN ET AL
.,
T
HE
F
UTURE OF
C
HILDREN
,
H
ISTORICAL
O
VERVIEW OF
C
HILDREN
’
S
H
EALTH
C
ARE
C
OVERAGE
(2003), available at http://www.futureofchildren.org/usr_doc/tfoc13-1c.pdf (last visited
Apr. 20, 2004).
Recognizing this problem, various members of Congress have introduced
legislation intended to address the dip and restore funding for SCHIP to the initial levels.
119
But consideration of the bills has been prolonged, which has led to a
reduction in federal funding at least in 2002. As long as the economy sputters along, states will fail to receive sufficient levels of revenue needed to maintain current levels of coverage. This is the weakness of any welfare-style program. Social insurance programs, such as Medicare and Social Security, are virtually impervious to fluctuating economic conditions because they are entitlements on which the government cannot default. SCHIP, however, is a discretionary program and policymakers can adjust eligibility criteria and benefits in response to larger budgetary pressures (by law states have to balance their budgets annually),
120
even
118. See Weil, supra note 64, at 18-19.
119. See e.g., S. 138, 108
th
Cong. (2003); Children’s Health Equity Act of 2003 S. 621, 108
th
Cong.
(2003).
120. C
AROL
S.
W
EISSERT
&
W
ILLIAM
G.
W
EISSERT
, G
OVERNING
H
EALTH
:
T
HE
P
OLITICS OF
H
EALTH
P
OLICY
208 (2d ed. 2002).
|
| |
| |
|
|
APSA 2004
U
NIVERSAL
C
OVERAGE
19
“Perfect Storm” currently battering Medicaid: growing demand for the program,
increasing medical inflation, and declining government revenues.
Figure 4
The SCHIP Dip: Enrollment and Federal Funding (Projected), 1998-2007
6
5
4
Enrollmen
t
(millions)
3
Funding
2
1
0
1998
1999
2000
2003
2004
2005
2006
2007
2001
2002
Year
($ billions)
Source: C
INDY
M
ANN ET AL
.,
T
HE
F
UTURE OF
C
HILDREN
,
H
ISTORICAL
O
VERVIEW OF
C
HILDREN
’
S
H
EALTH
C
ARE
C
OVERAGE
(2003), available at http://www.futureofchildren.org/usr_doc/tfoc13-1c.pdf (last visited
Apr. 20, 2004).
Recognizing this problem, various members of Congress have introduced
legislation intended to address the dip and restore funding for SCHIP to the initial
levels.
But consideration of the bills has been prolonged, which has led to a
reduction in federal funding at least in 2002. As long as the economy sputters
along, states will fail to receive sufficient levels of revenue needed to maintain
current levels of coverage. This is the weakness of any welfare-style program.
Social insurance programs, such as Medicare and Social Security, are virtually
impervious to fluctuating economic conditions because they are entitlements on
which the government cannot default. SCHIP, however, is a discretionary program
and policymakers can adjust eligibility criteria and benefits in response to larger
budgetary pressures (by law states have to balance their budgets annually),
118. See Weil, supra note 64, at 18-19.
119. See e.g., S. 138, 108
th
Cong. (2003); Children’s Health Equity Act of 2003 S. 621, 108
th
Cong.
(2003).
120. C
AROL
S.
W
EISSERT
&
W
ILLIAM
G.
W
EISSERT
, G
OVERNING
H
EALTH
:
T
HE
P
OLITICS OF
H
EALTH
P
OLICY
208 (2d ed. 2002).
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