Psychiatr News January 18, 2008
Volume 43, Number 2, page 10
© 2008 American Psychiatric Association
Final SCHIP Renewal Bill Fails to Expand Access
Rich Daly
Congress wrapped up 2007 by extending the State Children's Health
Insurance Program without a funding increase and leaving in limbo the
Democratic-led effort to significantly expand the popular health
initiative.
Congress extended a popular children's health insurance initiative
as one of its last acts of 2007.
The move to extend funding for the State Children's Health Insurance
Program (SCHIP) at current levels through March 2009 was part of a bare-bones
measure (S 2499) that also blocked a scheduled Medicare payment cut to
physicians (see Congress Votes Six-Month Delay in Threatened Medicare Cut).
SCHIP had operated under temporary reauthorizations, which expired December
21, 2007. The compromise measure provides enough money for states to continue
to serve their current enrollment levels—about 6 million people.
The legislation was designed to be narrow and noncontroversial to secure
President Bush's signature. Bush had vetoed two attempts to enact expansions
of the program, which would have allowed states to serve more children in
low-income families not poor enough to qualify for Medicaid.
It was on December 12, 2007, that Bush vetoed the second attempt to expand
SCHIP. That bill would have expanded the program by $35 billion over five
years, for a total of $60 billion, which supporters said would have covered 10
million children. It also would have limited SCHIP eligibility to families
earning up to three times the federal poverty level, or about $62,000 for a
family of four. But Bush—who advocated a smaller SCHIP
increase—cited the price tag and argued that the proposal would
"move children who already have private health insurance to government
coverage."
Bush also opposed raising tobacco taxes to pay for the expansion, a funding
strategy favored by Democrats. The bill would have raised the federal
cigarette tax by 61 cents, to $1 a pack.
Bush rejected a similar measure on October 3, 2007, and the House was
unable to override the veto. That bill did not cap eligibility, but it would
have allowed states to serve children from families earning more than three
times the poverty level if the state met certain conditions to make sure that
poorer children also were being served.
Most recently, Democrats and their Senate Republican allies had been in
intense negotiations with House Republicans for more than a month over SCHIP.
The aim of the talks was to create a third SCHIP bill that might draw a dozen
or so new House Republican votes, the margin Democrats thought they needed to
override Bush's veto.
Republicans said they would not support an expansion unless it limited
enrollment to children from families earning less than twice the federal
poverty level—or about $41,000 for a family of four—and included
strong prohibitions against enrollment of any adults or illegal immigrants in
the program.
Republicans viewed the 2009 SCHIP extension as a victory because Democrats
had threatened to use a shorter extension to make the fate of the popular
program an issue during the 2008 campaign season. Democrats may still attempt
an earlier renewal of the program, although the longer extension offers a
chance to secure Republican cooperation in expanding the program to cover more
uninsured children.
State officials and child advocates want any long-term extension to include
extra money to help the 21 states with shortfalls in federal SCHIP funding.
Such shortfalls are expected to total $1.6 billion in Fiscal 2008, according
to the Congressional Research Service.
APA and other physician groups supported the expansion of SCHIP as an
important means to extend health coverage to children who need mental health
care, said Nicholas Meyers, director of APA's Department of Government
Relations.
The text of the Medicare, Medicaid, and SCHIP Extension Act of 2007
can be accessed at
<http://thomas.loc.gov>
by searching on the bill number, S 2499. 
Related Article:
-
Congress Votes Six-Month Delay in Threatened Medicare Cut
- Mark Moran
Psychiatr News 2008 43: 1-35.
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