A children’s health bill could be one of the first pieces of legislation incoming President Barack Obama signs into law. This week both the House and the Senate took up bills to reauthorize the State Children’s Health Insurance Program (SCHIP), a popular and successful joint federal-state program that provides health insurance to children whose families earn too much to qualify for Medicaid but still cannot afford private health insurance. The program was originally supposed to be reauthorized in 2007 but, in spite of the fact that Congress passed two SCHIP reauthorization bills (H.R. 976 and H.R. 3963) with bipartisan support, they were both vetoed by President Bush. In the absence of a full reauthorization, SCHIP was temporarily extended until March 31, 2009. With an expiration date fast approaching and intent on giving President-Elect Obama a legislative victory during his first days in office, Democratic leadership slated SCHIP reauthorization as one of its first legislative priorities for 2009.
On January 14, the House overwhelmingly passed the Children’s Health Insurance Program Act of 2009, H.R. 2, by a vote of 289-139. Forty Republicans voted for the bill. On January 15, the Senate Finance Committee approved its own SCHIP reauthorization bill, 12-7. Though the House and Senate have separate bills, they are very similar and both closely mirror the SCHIP bills passed in 2007. Both bills would reauthorize the program for four and a half years, extending federal support for SCHIP through 2013; fund the program primarily with a 61-cent tobacco tax increase; allow states to cover families with incomes up to 300 percent of the federal poverty level with full federal SCHIP funding and give states the flexibility to set higher eligibility thresholds at lower federal funding rates; and provide health coverage to approximately 4 million additional uninsured children. Other key provisions in both bills include improvements to the benefits package to provide dental and mental health care services to children who need it, and giving states the option to use financial information collected from food assistance and other means-tested programs to identify and enroll eligible children. Regrettably, childless adults and parents will have to be phased out of the program, even though various studies show that covering children and their parents jointly results in greater health care coverage for children.  Also, a Medicaid requirement to document citizenship is extended to SCHIP, although states are allowed to verify applicants’ citizenship status via their Social Security number.

A critical provision that is now included in both bills is the state option to remove the five-year waiting period for immigrant children and pregnant women residing lawfully in the U.S. (this provision is often referred to as ICHIA – the Legal Immigrant Children’s Health Improvement Act). ICHIA was part of H.R. 2 from the onset, but was not in the original Senate bill. During mark-up the Senate Finance Committee adopted an amendment offered by Senator John Rockefeller (D-WV) to remove the five-year waiting period.  A recent national poll commissioned by First Focus found that the majority of Americans favor expanding SCHIP to cover legal immigrant children by a margin of 79-15 percent. (See a copy of the poll at: http://www.firstfocus.net/Download/ElectionNightPoll.pdf). Two other significant amendments the Committee adopted included one by Senator Charles Grassley (R-IA), which would require states to review SCHIP enrollees’ immigration status when re-checking their income levels, and another by Senator Olympia Snowe (R-ME) to allow states the option to offer dental insurance to children who are privately insured but lack dental coverage.

The Senate is expected to vote on the Finance Committee-approved bill within the next two weeks. Once the Senate votes, there will have to be a conference to resolve the differences between the Senate and House bills.

Advocates are happy that the 111th Congress has acted swiftly to reauthorize SCHIP. Given the economic crisis, the need for SCHIP reauthorization is even more important. A recent report by Families USA states that for every one percent increase in the unemployment rate, an estimated 600,000 children become eligible for Medicaid or SCHIP. From December 2007 to December 2008 the unemployment rate has jumped 2.3 percentage points. This same report demonstrates the positive impact SCHIP reauthorization would have across the country – it lists state-by-state figures of the number of children that would gain coverage under H.R. 2. (See Families USA’s report at: http://www.familiesusa.org/assets/pdfs/yes-we-can-chip-2009.pdf.)

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