Members of Congress, state officials and advocates hope to expand the State Children’s Health Insurance Program (SCHIP), a popular and successful joint federal-state program that provides health insurance to children whose families have low incomes but earn too much to qualify for Medicaid.  The program, which was created in 1997 by the Balanced Budget Act, is up for reauthorization for the first time this year.  Many view the reauthorization process as an opportunity to make improvements in SCHIP and Medicaid, its larger companion program, so that they reach more eligible children.
In fiscal year 2006, over 6 million children were enrolled in SCHIP at any point during the course of the year, according to the Department of Health and Human Services.  Since SCHIP’s inception and related improvements in Medicaid outreach, the number of uninsured children has fallen by one-third.  Yet, despite these great achievements, there are still 9 million uninsured children in the United States, many who are eligible for SCHIP and Medicaid but are not enrolled.  As Congress prepares for reauthorization, different groups have set forth recommendations for building on SCHIP’s success so that it reaches at minimum the 6 million children who are eligible but not currently enrolled. Though many Members of Congress and SCHIP supporters agree that the programs success hinges on increased funding there is no consensus as to how much of an increase should be provided through reauthorization.

In early February over 50 national organizations signed a letter to Members of Congress outlining a set of priorities for SCHIP reauthorization.  The letter asks for $60 billion in new funding for children’s health over the next five years.  The increased funds would allow states the tools to enroll more eligible children in SCHIP and Medicaid and ensure that no child who is currently enrolled loses coverage due to funding shortfalls.  It also asks that the legislation include a state option to cover more pregnant women through SCHIP and expand SCHIP and Medicaid coverage to immigrant children and pregnant women in the country less than 5 years.  Access to services like mental health and dental care should also be expanded. (To read the letter, which the Coalition on Human Needs also signed click here)

Governors, who were in Washington, D.C. earlier last week for the annual National Governors Association winter meeting, made a similar plea to Congress and the Administration.  In a bipartisan letter sent to Congressional leaders they urged Congress to begin work on the reauthorization of SCHIP early, and highlighted state flexibility and sufficient federal funds as key ingredients for the continued success of the program.  Governors also pressed the President and Congress to provide additional funds for SCHIP this year to prevent any states from having funding shortfalls before reauthorization.

Currently, fourteen states face federal funding shortfalls in SCHIP this year.  These states are Alaska, Georgia, Illinois, Iowa, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, Rhode Island and Wisconsin.  Lack of sufficient federal funds may mean that these states will have to cut back their SCHIP program.  Georgia has already announced that as of March 11 it will bar any new children from enrolling in the program.

Senior Democrats assured the Governors that this year’s shortfalls would be addressed.  Rep. David Obey (D-WI), Chairman of the House Appropriations Committee has said that the supplemental spending bill for military operations in Iraq and Afghanistan would include money to cover the SCHIP shortfalls.  Rep. Frank Pallone (D-NJ), who chairs the Energy and Commerce Subcommittee on Health, the committee with jurisdiction over SCHIP reauthorization, has made similar statements.

Over the last couple of weeks various Members of Congress have announced proposals to expand SCHIP.  Rep.Rahm Emanuel (D-IL), the fourth-ranking member of the House Democratic leadership, is working on a $60 billion bipartisan plan with two senior Republicans, Ray LaHood of Illinois and Jim Ramstad of Minnesota.  According to paygo rules increases in entitlement programs must be offset with program cuts or revenue increases.  Rep. Emanuel proposes paying for the proposed expansion with legislation to improve collection of capital gains taxes.  Sen. Richard Durbin (D-IL), the second- ranking Democratic Senator, has agreed to submit a companion bill in the Senate.  This week, Sen. Gordon Smith (R-OR), who sits on the Finance Committee, announced that he also supports an SCHIP expansion and suggested that Congress should double the federal cigarette tax to pay for it.  Rep. John Dingell (D-MI), Chairman of the House Energy and Commerce Committee, is expected to introduce his proposal this week.  Advocates expect that other bills will be introduced.  Deliberation over SCHIP reauthorization is expected to begin in late Spring.

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