Struggle With KidCare Money Debate
Published: Aug 1, 2007
TALLAHASSEE - "If you're healthy and
you know it, then your face will surely show it; if you're healthy and you
know it, clap your hands."
Beaming girls and boys take turns singing new lyrics to the
old tune in a television ad, now playing on cable news channels.
"It makes my heart sink," said Alex Sink, Florida's chief
financial officer. "Every time I see one of those ads, I keep thinking about
all this potential extra money that's going to be made available that, at
this point and time, other states will soak up because those other states
have good public health policy."
The ad, bankrolled by the pharmaceutical lobby, urges
Congress to reauthorize the State Children's Health Insurance Program, or
S-CHIP, a federal program that provides matching funds for health insurance
that states provide to low-income children. S-CHIP will expire this year
unless Congress renews it.
Most stakeholders and politicians agree on continuing
S-CHIP, but debate over how to do it is in full swing on Capitol Hill. The
Senate took up a bill this week that would pour an additional $35 billion
into the $25 billion program. The House continues to fine-tune its version,
which would add $50 billion. Meanwhile, President Bush is proposing $5
billion more and threatening to veto any attempt at significant expansion.
In Florida, it's not the veto threat that frustrates Sink
most. Instead, she's dismayed that the debate seems to mean so little here,
in light of millions in S-CHIP matching dollars that Florida has forfeited.
This year, Florida will lose $20 million in S-CHIP money the state failed to
spend in 2005 on KidCare, the state's health insurance program for
Advocates and bureaucrats disagree over Florida's risk of
losing future S-CHIP funds, but most agree the relationship between S-CHIP
and KidCare has been a roller coaster since the beginning in 1998.
Sink, a Democrat who as CFO presides over much of KidCare,
said the Legislature is unlikely to improve the program this year. She is
looking for new ways to end paperwork headaches for parents and solve other
problems that keep out eligible children.
"We drop thousands of kids off the program every month,
because of some of these administrative hassles," Sink said. "Time's
The federal S-CHIP program provides a
2-to-1 federal match for states to cover the health care costs of low-income
children who do not qualify for Medicaid. In Florida, S-CHIP dollars cover
about two-thirds of the cost of KidCare enrollment for about 224,000
children, with Medicaid covering enrollment for 1.1 million of those with
the lowest incomes.
Democrats in Congress are confident efforts to authorize and
expand S-CHIP will gain significant majorities in both chambers. But battles
are expected to get intense.
In the House, Republican Adam Putnam of Bartow sees S-CHIP
expansion as a move toward covering all Americans through Medicare, Medicaid
or S-CHIP and "a bureaucracy that makes decisions about people's health care
and remove patient choices."
Democratic Rep. Kathy Castor of Tampa, meanwhile, is an
ardent proponent of expansion, calling it "the best thing going for not just
kids and parents, but for state government itself" because the federal
government provides 71 cents for every 29 cents the state provides.
Still, Florida controls much of its own destiny when it
comes to insuring its poor children, and reforming KidCare has steadily slid
down the list of legislative priorities in Tallahassee this year.
Florida's Uninsured Children
According to a revised 2005 U.S. Census
report on health insurance, about 488,000 of the state's more than 700,000
uninsured children live in families with incomes low enough to qualify for
KidCare, including those with incomes low enough for enrollment through
Strict payment, documentation and eligibility requirements
"that might not be viewed as consumer friendly have been dogging the program
since the beginning," said Les Beitsch, director of the Florida State
University Center on Medicine and Public Health and former deputy secretary
at the state Department of Health.
A bipartisan coalition of state lawmakers tried this spring
to expand eligibility and simplify KidCare, which stretches across four
state agencies. But Senate leaders refused, citing a lack of consensus among
agencies and other stakeholders.
Since then, lawmakers and advocates have repeatedly raised
the prospect of fixing KidCare during a special session. But as leaders have
announced one session after the next, they have left KidCare out. House
Speaker Marco Rubio and Senate President Ken Pruitt have called for limiting
the session Sept. 18 to state budget cutting only.
"It's going to be very difficult in a budget-cutting session
to get more for this program," said Rep. Bill Galvano, R-Bradenton, chairman
of the House Healthy Families Committee. "The discussion sort of ended when
the Senate made clear they were not going to put any more money towards
KidCare in a special session."
On Monday, Galvano joined a committee created by Sink to
find nonlegislative ways to improve Healthy Kids, the non-Medicaid part of
KidCare that Sink oversees. The committee is recommending several fixes,
such as billing families during the first month of coverage, rather than
requiring advance payment before enrolling a child, and offering payroll
deduction as a payment option.
Such changes should help, said Chris Card, a social worker
who heads Sink's committee and sits on the Healthy Kids board. But he
expressed frustration that state lawmakers have lost their appetite to
address KidCare this year, even as federal lawmakers hammer out new S-CHIP
rules and funding formulas.
"We need to position ourselves to best take care of our kids
in Florida," he said. "How can we, at this point, even inform our
congressional delegation as to what is in our best interest?"
Like Card, state leaders and advocates generally agree that
increasing S-CHIP funding gives Florida KidCare the best chance at expanding
in the future. But they disagree as to which of the S-CHIP proposals would
serve the state best.
Versions Of The Story
Healthy Kids Director Rose Naff said
Florida would benefit under the U.S. Senate's funding plan. Longtime child
advocate Karen Woodall argued that only the House version would provide
crucial flexibility, particularly regarding eligibility. Naff also sides
with the White House on stopping a handful of other states from spending
S-CHIP dollars on insurance for low-income parents and other adults, arguing
that stopping the practice will free up more money to cover the nation's
children in Florida and elsewhere.
Woodall disagreed. "What other states do with their
allocation of dollars doesn't affect us."
Naff and Woodall offered different views of the state's loss
of S-CHIP funds over the years. Woodall noted that the state has lost $139.7
million in unspent funds since 1998, the result of low state spending and
underenrollment. Every dollar Florida has given up deprived a child of
KidCare coverage, she said.
That's true, said Naff, but Florida has also spent enough in
other years to reap extra funding, ultimately bringing the state's net gain
to $29.6 million. The $20 million loss of funds this year, Naff added,
results partly from a change in how federal officials redistribute unspent
State Rep. Galvano, who plans another attempt at reforming
KidCare next year, said he has heard both versions of the story. It still
boils down to 500,000 uninsured children who could be enrolled in KidCare
today, he said.
"As long as those eligible kids are not in the program, we
are missing an opportunity," he said. "We are leaving federal dollars on the
Reporters Billy House and Carol Gentry contributed to
this report. Reporter Catherine Dolinski can be reached at (850) 222-8382 or