Fact Checker: Is Clinton overstating role in children’s health coverage?

Introduction

'When millions couldn't get health care, this first lady worked with Republicans and Democrats to fix it, creating the Children's Health Insurance Program. Now 8 million kids are covered.”

Source of claim: A television ad airing in Iowa, called 'Quiet Moments,” from Hillary for America, the campaign committee for likely Democratic presidential nominee Hillary Clinton.

Analysis

The ad references Clinton's time as first lady from 1993 to 2001.

We examine if millions of children couldn't get health care then, Clinton's role in establishing the Children's Health Insurance Program and how many children are now covered.

Josh Schwerin, a Clinton aide, provided Fact Checker numerous sources for the claim including federal reports and citations from news media articles.

The State Children's Health Insurance Program or SCHIP, which later was shortened to the Children's Health Insurance Program or CHIP, was established by the Balanced Budget Act of 1997 as the number of uninsured children was growing. The program was designed to fill the gap for those who couldn't afford private insurance but weren't poor enough for Medicaid, according to the National Conference of State Legislatures.

U.S. Census Bureau data shows the number of uninsured children had grown to 11 million by 1998, but only about 30 percent of them, or 3.4 million kids, were considered poor.

In the first year, 1998, the program had 660,000 children enrolled, 2 million by the second year and 5.4 million by the fifth year, according to data from a May 2007 paper by the Congressional Budget Office, a nonpartisan research group for Congress. It's corroborated in a September 2007 report from the Centers for Medicare & Medicaid Services.

In the same paper, the CMS said between 10 and 56 percent of enrollees, with a working number of 33 percent for purposes of Congressional reauthorization, had simply moved from private insurance to public coverage because it was better or cheaper.

According to CBO figures, for every 100 children enrolled in the program, a corresponding reduction of 25 to 50 occurred in private insurance. Looking from another direction, 50 to 75 percent of enrollees had previously not been insured, according to the report. This translates to millions of children who hadn't previously been insured becoming insured by the third year of the program.

Other CBO data shows the uninsured rate fell from 22.5 percent in 1996 to 16.9 percent in 2005 among children falling between 100 percent and 200 percent of the poverty level, which is the population most eligible for the health insurance program.

As for Clinton's role in ushering in the program, evidence is more anecdotal.

Clinton has been touting the program as one of her accomplishments for years in ads and speeches. Her aide, Schwerin, pointed to a variety of news clippings of public statements backing up her role and other fact checking outlets validating the claim.

We found a 1999 news release about Clinton's work with governors on a national initiative to build enrollment in SCHIP, as one example, and citations from speeches she gave at the time.

The ad gives passing mention to work with 'Republicans and Democrats.” Sens. Ted Kennedy, D-Massachusetts, and Orrin Hatch, R-Utah, co-sponsored the legislation that ultimately created SCHIP.

A 2008 Boston Globe article disputed Clinton's efforts, with Hatch, in discussing who should get credit, quoted as saying, 'Teddy does, but she doesn't.” The year before, Kennedy had a different take, saying the program 'wouldn't be in existence today if we didn't have Hillary pushing for it from the other end of Pennsylvania Avenue.”

A previous Fact Checker reviewed part of this claim as well and noted Gene Sperling, a Clinton campaign adviser who served as one of President Bill Clinton's lead budget negotiators in 1997, telling the Associated Press in 2007 that Hillary Clinton favored boosting the SCHIP to $24 billion, instead of $16 million proposed as part of a compromise.

'I remember her having a lot of influence - you're getting this done because you know the first lady wants it,” Sperling was quoted as saying.

The final aspect of the claim addresses how many people are currently enrolled. According to the Kaiser Family Foundation, 8,129,426 were enrolled in 2014, the latest year of data.

Conclusion

It is somewhat of a semantic debate about whether someone 'couldn't” get health insurance, as the Clinton ad states. Did they choose not to get insurance? Could they not afford it? Were they aware of options?

It is accurate that, even on top of the children who moved over from private to public coverage, millions of children hadn't been insured and then became insured through the Children's Health Insurance Program. Several sources also verify the claim of 8 million children currently enrolled.

We can't empirically measure Clinton's effort in establishing the health care program, and opinions about her influence from those close to the situation are split along partisan lines. Clinton clearly played a role, but Kennedy and Hatch led the legislation.

We score the claims measured in the Clinton ad a ‘B.'

Criteria

The Fact Checker team checks statements made by an Iowa political candidate/office holder or a national candidate/office holder about Iowa, or in advertisements that appear in our market. Claims must be independently verifiable. We give statements grades from A to F based on accuracy and context.

If you spot a claim you think needs checking, email us at factchecker@thegazette.com.

This Fact Checker was researched and written by B.A. Morelli.