What's Ahead for Children's Health Insurance?
The United States Senate and the House of Representatives in late September passed a compromise bill reauthorizing the State Children’s Health Insurance Program (SCHIP). President Bush has said he will veto the bill, H.R. 976, which would provide an additional $53 billion in federal matching funds to states over the next five years, to enable states to add additional children to the insurance program. The President had asked for a much smaller increase in funds -- $5 billion -- which would have covered only children already in the program.
Apparently sure that the U.S. House of Representatives will uphold the promised veto, SCHIP supporters said last week that they will return to the table to work out new legislation. Meanwhile, Congress has approved an extension of the SCHIP program with existing rules and funding levels through the end of this calendar year.
If the compromise bill were enacted into law, it would make some changes in the very popular federal/state child insurance program. Here are some of the provisions of that legislation that may or may not make it into a new bill now expected to be crafted by House and Senate committees in the next session of Congress.
Under H.R. 976, the Children's Health Insurance Reauthorization Act of 2007,
• Pregnancy-related assistance would be provided to targeted low-income pregnant women (incomes up to 185 percent of the federal poverty level), with postpartum care through 60 days following the end of the pregnancy. Babies born to the women would be enrolled in SCHIP automatically.
• Coverage to non-pregnant childless adults would be phased out, with states that have waivers allowing such coverage given options for ending it.
• The federal matching rate for children from families earning more than 300 percent of the federal poverty level would be limited.
• There would be extensive studies of whether enrollment in SCHIP "crowds out" private insurance coverage—in other words, whether families move their children from private health plans to enroll them in SCHIP.
• Current requirements that SCHIP applicants present documentary evidence of citizenship would be replaced by other assurances of eligibility.
• There would be extensive examination of health quality improvements for children enrolled in SCHIP and improved availability of public information regarding enrollment of children in Medicaid and SCHIP.
• Dental benefits and mental health parity would be ensured under SCHIP plans.
• There would be demonstration projects relating to diabetes prevention.
• Provisions regarding school-based health centers would be clarified to say that nothing in the law prevents states from providing payment for items and services provided by SBHCs.
• The program would be financed by an increase in the excise tax on tobacco products.
• There would be no federal funding for illegal aliens.
The State Children's Health Insurance Program was passed by Congress 10 years ago, in 1997, and the original authorization expired at the end of September this year. The reauthorization proposal now before President Bush inspired heated debate in both the House and Senate, with critics charging that the bill’s provisions for child health insurance are an opening wedge to government-financed universal health coverage, and advocates arguing that the program should be extended to cover at least 10 million children, up from the 6.6 million currently enrolled in SCHIP.
The compromise bill was supported by organizations including the American Medical Association and the AARP, and by many state governors. Supporters of the bill warned during debate that congressmen who vote to sustain the President’s veto will face the issue when they stand for reelection next year.
