This week, the House and Senate each approved a bill to reauthorize the State Children’s Health Insurance Program (SCHIP). A House-Senate conference committee will meet after the August recess to reconcile the differences in the two measures. President Bush has indicated he plans to veto both versions of the bill.
SCHIP was created by the Balanced Budget Act of 1997 (P.L. 105-33) and provides health insurance to low-income children who are ineligible for Medicaid but unable to obtain private health insurance coverage. SCHIP’s current authorization expires on September 30, 2007.
House
On August 1, the House approved, 225-204, the Children’s Health and Medicare Protect (CHAMP) Act (H.R. 3162), after rejecting, 202-226, a motion to recommit by Rep. Kay Granger (R-TX). The motion to recommit would have extended the current program for one year. The House Ways and Means Committee approved the measure on July 26; the House Energy and Commerce Committee began debating the bill the same day, but adjourned when committee Republicans delayed consideration to protest the lack of a legislative hearing on H.R. 3162 (see The Source, 7/27/07).
The rule governing debate on the CHAMP Act amended the bill. Under the rule, the bill would index for inflation the asset limits for Medicare eligibility (currently $1,000 for individuals and $2,000 for couples) and would extend the Transitional Medical Assistance (TMA) program until 2011, rather than 2009. It also would reauthorize abstinence education programs by “ensur[ing] [that] medically- or scientifically-accurate information is provided; states have the flexibility to teach abstinence-only education programs or abstinence-plus education programs; and funded programs are proven effective at decreasing teen pregnancy rates and rates of STDs [sexually transmitted diseases] and HIV/AIDS.” For more information on TMA and the abstinence education program, please see The Source, 7/16/07).
Speaker Nancy Pelosi (D-CA) said, “When I was sworn in as Speaker, I was surrounded by children. It was very exhilarating, and I called the House of Representatives to order on behalf of all of America’s children, establishing this chamber as the champion for our children and for the future. Our legislation is called CHAMP because it does just that. It champions quality health care for America’s children and for our seniors, strengthening families. It is just one way in which this ‘New Direction Congress’ is putting health care and particularly the needs of our children at the top of the nation’s agenda.” She praised the SCHIP programs, saying, “SCHIP has dramatically reduced the number of poor, uninsured children in America. The legislation before us today will improve SCHIP and the lives of millions of working families in America by improving coverage for all six million children currently insured under SCHIP and by extending that coverage to five million additional children. Those children will receive dental care and, thanks to Congressman Patrick Kennedy [(D-RI)], mental health services…By passing the CHAMP Act, the ‘New Direction Congress’ is keeping our promise to seniors on Medicare and meeting our obligation to our future, our children. Again, and it is paid for. I can’t say that enough. I’ll just say in conclusion, Mr. Speaker, as Pearl Buck said, ‘If our American way of life fails the child, it fails us all.’ With this CHAMP Act, we are not going to fail America’s children. We are championing them and their grandparents.”
“My motion to recommit reauthorizes the SCHIP program for one year and provides states with the resources they need to be able to continue to provide needed health care coverage for children,” said Rep. Kay Granger (R-TX). She continued, “The SCHIP program is a good program. It ensures [that] mental [health] care is available to children who are needy but who are not poor enough to qualify for Medicaid…Let there be no doubt, Republicans support SCHIP, because we were instrumental in its creation 10 years ago. We don’t support the reckless underlying bill that raises taxes and cuts Medicare by $200 billion, taking health care away from some of our neediest seniors. The underlying bill is the first step to government-controlled health care and takes America in the wrong direction…It takes a sensible, bipartisan program aimed at helping low-income children and turns it into a monster that will suck millions of middle-class Americans into government-run health care. The bill would create a massive new entitlement with totally inadequate funding.” Rep. Granger raised concerns about the bill’s cuts to Medicare Advantage saying, “The cuts proposed by the Democrats in Medicare will result in nearly 3.2 million seniors losing their Medicare Advantage coverage…In my district, 17,279 Medicare Advantage enrollees will lose their benefits if the Democrat CHAMP Act passes…If the motion fails, I strongly urge my colleagues to vote against the Democrat CHAMP Act.”
Senate
On August 2, the Senate approved, 68-31, the Children’s Health and Medicare Protect (CHAMP) Act (H.R. 976), after adopting, by unanimous consent, a substitute amendment by Sens. Max Baucus (D-MT) and Charles Grassley (R-IA). The substitute amendment incorporates the language contained in S. 1893; that bill was approved by the Senate Finance Committee on July 19 (see The Source, 7/20/07).
During debate on the measure, the Senate defeated the following amendments:
- an amendment by Sens. Trent Lott (R-MS) and Mitch McConnell (R-KY) to expand SCHIP by $9.3 billion over the next five years, offset by reducing federal reimbursements for administrative expenses in the program and by creating small business association health plans, 35-61;
- an amendment by Sen. John Ensign (R-NV) to dedicate the bill’s tobacco tax revenue to research at the National Institutes of Health instead of an expansion of SCHIP, 26-58;
- an amendment by Sen. Judd Gregg (R-NH) to end coverage of non-pregnant adults under SCHIP immediately, 42-53;
- an amendment by Sen. John Kerry (D-MA) to increase the program by $15 billion, offset by raising the top income tax bracket to 39.6 percent, from 35 percent, for people with taxable income of $1 million or more, 36-60;
- an amendment by Sen. Wayne Allard (R-CO) to allow states the option to extend SCHIP coverage to unborn children, 49-50; and
- an amendment by Sen. Kay Bailey Hutchison (R-TX) to require the secretary of Health and Human Services to adjust the federal poverty line for high cost counties or metropolitan areas and, once adjusted, to prohibit coverage for families earning more than 200 percent of the adjusted poverty line, 21-78.An amendment by Sen. Jim Bunning (R-KY) that would have struck a provision of the bill allowing some states to cover children from families earning more than three times the poverty line, was tabled, 53-43.
“The State Children’s Health Insurance Program was created to target the health care needs of poor children whose families made too much to be eligible for Medicaid, but were still in danger of not being able to afford private health insurance,” said Sen. McConnell. He continued, “SCHIP is in many ways successful, as last year, 6.6 million children had health care coverage thanks to it, including more than 50,000 in the Commonwealth of Kentucky.” Sen. McConnell explained his amendment, saying “The Kids First [amendment] will reauthorize SCHIP for five years and would ensure that children enrolled in SCHIP stay covered by adding $14 billion in funding above and beyond the baseline SCHIP budget. Our alternative will add 1.3 million new kids to the SCHIP program by 2012. By contrast, the Finance Committee bill actually begins reducing kids’ coverage in 2012 and results in fewer children having SCHIP coverage in 2017. Our alternative also provides $400 million over the next five years for states to spend on outreach and enrollment for low-income children who are eligible but not on SCHIP, so we can enroll them. This money will help guarantee that SCHIP dollars go toward the low-income kids the program is meant to help…It also includes the small business health plan legislation we considered in the 109th Congress. Of the 20 million working Americans who do not have health insurance, nearly half work in firms of 25 or fewer…Finally, our alternative ensures that the taxpayers’ dollars are spent appropriately by decreasing the number of adults who can take advantage of the program…Our plan is fiscally responsible and focuses government assistance on those who really need it. It reauthorizes and improves upon a program that works instead of transforming it into a license for higher taxes, higher spending, and another giant leap toward government-run health care. It can receive a presidential signature, and it deserves this Senate’s support.”
Sen. Blanche Lincoln (D-AR) said, “This proposal also takes steps to ensure that [children] get a healthy start by providing care for pregnant women and establishing pediatric quality measures to improve the level and efficiency of the care they do receive…I have long supported improving access to health care coverage for pregnant women, not only because it is vital to the health of mothers and infants, but it also often reduces future health care costs. What an incredible return on our money to see expectant mothers going full-term to deliver a child that has a much greater opportunity to perform, to be healthy, and to be less costly later in life due to health care needs. In fact, it was reported in 2005 that the socioeconomic costs medical, educational, and lost productivity associated with preterm birth in the United States were at least $26.2 billion.” Sen. Lincoln shared her personal story with the Senate, saying, “I know when I served in the House of Representatives and my husband and I were so excited to receive the news that we were expecting twins, I also received the news that at my age, and certainly the work environment I was in and all of the pressures, I was also at risk for a premature delivery. I had the wonderful opportunity to make a decision that I would not run for reelection and that I could minimize my job in order to do everything within my power to bring those children into this world in a safe manner. I look across this great country, and not all working mothers have that opportunity. They don’t have those choices to be able to step aside and do everything they possibly can with the health care they receive to bring their babies into this world in the healthiest fashion. One thing we can do is to provide them the prenatal care they need and the advice and consultation to be able to do what they can to ensure those babies are delivered after a full term. By taking needed steps to improve access to care for pregnant women, I am confident we can make strides to improve health outcomes for them and for their children.”
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