CHN: Déjà vu on Children’s Health Bill

The House passed a new version of the children’s health bill (H.R. 3963) on October 25, almost two weeks after the President vetoed the original bill (H.R. 976). However, the 265-142 vote, though bipartisan, was not enough to secure the veto-proof margin proponents of the bill had hoped for.  The President has threatened to veto this bill too.
H.R. 3963 is much like the original bill the President vetoed, except it was modified to address concerns raised by Republican opponents of H.R. 976. Just like the original bill, it includes a $35 billion increase over 5 years to be paid for by a 61 cent tobacco tax increase and according to the Congressional Budget Office (CBO) would continue to cover almost 4 million otherwise uninsured children by 2012.  This keeps with the House and Senate leadership’s commitment to insure 10 million children in all through the reauthorization of the State Children’s Health Insurance Program (SCHIP).  Currently an estimated 6 million children are enrolled in SCHIP and Medicaid.

The revisions, crafted to attract more Republican support for the bill, include measures to:

  • Further target low-income uninsured children. The new bill, for the first time in the history of SCHIP, sets an income restriction.  If approved, no state could provide SCHIP coverage to children in families with incomes above 300% of the poverty line.  The only exception would be New Jersey, which is the only state that currently covers children above this level.  Additionally, states would only receive financial incentives for enrolling uninsured children who are eligible for Medicaid.  The revised bill drops the incentives included in the original bill for enrolling children in families with slightly higher-incomes who are eligible for SCHIP.
  • Hasten the elimination of adult coverage. Coverage of childless adults would be phased out in one year instead of the two years stipulated in the original bill.
  • Limit “crowd-out” or substitution.  The new bill requires all states to implement best practices developed by the Secretary of Health and Human Services to reduce substitution of SCHIP for private coverage.  This was only required for states covering children above 300% of the poverty line in the original bill.
  • Guarantee that undocumented immigrants are not enrolled in Medicaid and SCHIP.  H.R. 3963 tightens provisions included in the original bill in this area. H.R. 976 extended a problematic citizenship documentation requirement for Medicaid to SCHIP and gave states a mechanism for checking applicants’ eligibility.  States could opt to confirm an applicants’ eligibility by matching their names and Social Security numbers with information in the Social Security Administration (SSA) database.  The new bill requires that states go a step beyond this and not only confirm names and Social Security numbers but also citizenship status from the information in the SSA database.

(For a more detailed summary of the bill see the Center on Budget and Policy Priorities’ analysis of H.R. 3963:

Despite these changes opponents were not swayed.  Though the revised bill managed to pick up an additional Democratic vote (leaving only one Democrat in opposition to the bill), no new Republican votes were gained.

House and Senate leadership want to move quickly on the revised bill given the few legislative days remaining before the Thanksgiving Recess and the November 16 expiration of the SCHIP short-term extension. Senate Majority Leader Harry Reid (D-NV) has stated that he would like to schedule a vote in the Senate next week.  According to House Majority Leader Steny H. Hoyer (D-MI) there is a chance that additional changes will be made in the Senate to try to garner more Republican support.

Budget Report 2012 - Self-Inflicted Wounds