Expanding Coverage for Children — The Democrats' Power and SCHIP Reauthorization (New Eng Jour Med)

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http://content.nejm.org/cgi/content/full/360/9/855?query=TOC

Expanding Coverage for Children — The Democrats' Power and SCHIP Reauthorization
John K. Iglehart

In the first demonstration of Democratic dominance on health care issues since Barack Obama captured the White House, the new Congress quickly reauthorized the State Children's Health Insurance Program (SCHIP), enabling the president to sign the measure into law within days after taking office. Though falling short of President Obama's goal of ensuring that "every child in America has access to affordable health care," the measure should sustain SCHIP's current enrollment of about 7 million and expand coverage to an additional 4.1 million children by 2013.

The rapid action underscored Democrats' intention to reverse or amend many health policies put in place during the Bush administration. Twice in 2007, Democrats failed to override vetoes of similar SCHIP bills by former President George W. Bush, who objected to their financing of the program through increased federal tobacco taxes and to their going "too far in federalizing health care." But the newly authorized SCHIP expansion still faces a formidable hurdle. With federal and state governments seeing substantial losses in tax revenue as the recession deepens,1 many states will find it challenging to stabilize, much less expand, their current SCHIP and Medicaid enrollments, even as more people lose their jobs and their employer-sponsored health insurance.2 A large economic stimulus package moving through Congress contains substantial relief for states, including monies to bolster SCHIP and Medicaid programs.

On January 14, eight days after the 111th Congress convened, the House approved a 4.5-year extension of SCHIP by a vote of 289 to 139. The bill attracted 40 Republican votes, reflecting some bipartisan support for expansion of public coverage for the most politically popular uninsured group, children who live in low-income families, most of which have an employed family member. On January 29, the Senate voted 66 to 32 in favor of a similar bill. Only nine Republican senators voted for the measure. Legislators quickly resolved the only issue that separated the House and Senate measures. They eliminated from the final bill a House-approved provision that would essentially have banned the future development of specialty hospitals owned or invested in by physicians who refer patients to these facilities. President Obama signed the bill into law on February 4.

SCHIP was established by the Balanced Budget Act of 1997 as a federal–state program serving children living in families with incomes at or below 200% of the federal poverty level ($35,200 for a family of three in 2008). SCHIP expanded on coverage provided by Medicaid, a far larger federal–state program covering some 60 million people (almost half of them children) with incomes below the poverty level ($17,600 for a family of three in 2008). However, states were granted the flexibility to set their own eligibility levels, and 44 states have since expanded their coverage of children (through either a newly created SCHIP or an expansion of their Medicaid programs) to those with family incomes of 200% of the federal poverty level or higher. New Jersey enrolls children with family incomes up to 350% of the poverty level — the highest threshold of any state.

Source Information
Mr. Iglehart is a national correspondent for the Journal.

The New England Journal of Medicine is owned, published, and copyrighted © 2009 Massachusetts Medical Society. All rights reserved.

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http://content.nejm.org/cgi/content/full/360/9/855?query=TOC