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The Senate on Thursday voted 66-32 to approve legislation (HR 2) that would reauthorize SCHIP and expand coverage to about four million additional children over the next four-and-a-half years, the Washington Post reports (Connolly, Washington Post, 1/30). SCHIP is set to expire on March 31. Under the bill, children in families with incomes of up to three times the federal poverty level would qualify for the program. The measure would exempt New Jersey and New York state from those income eligibility requirements and would allow the states to expand coverage to children in higher-income families. The bill also would eliminate a five-year waiting period for documented immigrant children and pregnant women to become eligible for the program (Freking, AP/Houston Chronicle, 1/29).

The measure, which would increase SCHIP spending by $32.8 billion over the four-and-a-half-year period, would be funded by a 62-cent-per-pack increase in the federal cigarette tax, according to a recent Congressional Budget Office estimate (Armstrong, CQ Today, 1/29). CBO estimates that the bill would provide coverage for the additional four million children by 2013, while continuing coverage for seven million children already in the program.

No Senate Democrats voted against the bill, and nine Republicans voted in favor of the legislation (Pear, New York Times, 1/30). The bill now moves to the House. House Majority Leader Steny Hoyer (D-Md.) said that because the House and Senate versions of the bill are so similar, the House would clear the Senate bill and send it to President Obama without holding a conference on the legislation (CQ Today, 1/29). The Senate bill does not include a provision included in the House version that would have prevented new physician-owned hospitals from opening (AP/Houston Chronicle, 1/29).

Amendments
Senators adopted an amendment proposed by Sen. Jeff Bingaman (D-N.M.) that would eliminate a requirement that parents provide a signature on official government forms when enrolling them through a process known as the "Express Lane." Several amendments proposed by Republicans were voted down, including language that would have given funding priority to states with a higher percentage of uninsured residents; eliminated all existing federal exemptions for states that cover families with incomes greater than 300% of the federal poverty level; and allowed states to provide premium assistance for purchasing private coverage to families with incomes greater than the current SCHIP eligibility limit of two times the poverty level (CQ Today, 1/29).

Comments
Senate Finance Committee Chair Max Baucus (D-Mont.) said, "When President Obama signs this bill, the real victory will belong not to politicians, but to kids" (AP/Houston Chronicle, 1/29). Sen. Sherrod Brown (D-Ohio) said, "It's my sincere hope that passage of this legislation will be the beginning of a major overhaul of American health care, which ultimately will provide coverage to all Americans."

Sen. John McCain (R-Ariz.) said, "Some of us who look at this bill may view it as another effort to eliminate, over time, private insurance in America, and I am concerned about that" (New York Times, 1/30). Sen. Orrin Hatch (R-Utah) said, "To start out the year on this note does not bode well for future health care discussions, including health reform" (Levey, Los Angeles Times, 1/30). Senate Finance Committee ranking member Chuck Grassley (R-Iowa) said, "We know the rest of the year in health care, we've got big things ahead of us. Four million uninsured Americans down, but 42 million uninsured Americans to go. That won't be an easy task." He said, "Think of (this debate) as laying the groundwork for a lot of debate we're going to have," adding, "Basic questions: Do we want government-run solutions? Is growing our government bureaucracy in the area of health care the pathway to covering all Americans?" (Meckler, Wall Street Journal, 1/30).

Global Fund Urges Governments To Sustain Funding Commitments Amid Economic Downturn

The Global Fund To Fight AIDS, Tuberculosis and Malaria on Thursday urged donor governments to sustain funding commitments in order to close the organization's $5 billion funding gap over the next two years, the Los Angeles Times "Booster Shots" blog reports. Advocates for the Global Fund made their appeal during a teleconference call from the World Economic Forum in Davos, Switzerland (Engel, "Booster Shots," Los Angeles Times, 1/30).

Although some donors might find it "tempting to scale back" donations, this "would be exactly the wrong strategy," Peter Chernin, chair of Malaria No More, said. According to the Inter Press Service, the Global Fund's 2009 to 2010 budget was projected to be $8 billion but only $3 billion currently is available, including donor governments' existing commitments (Xanthaki, Inter Press Service, 1/29). Rajat Gupta, chair of the Global Fund, said the organization "is not immune to the environment today of the global financial crisis," adding that "we need U.S. leadership because right now I think the U.S. is lagging behind." According to AFP/Google.com, officials estimate that about half of the $5 billion shortfall could be coming from the U.S. (AFP/Google.com, 1/30). Jeffrey Sachs, director of the Earth Institute at Columbia University and adviser to the United Nations' secretary-general, said that the U.S. spends only 0.16 of 1% of its income on development assistance, which is the "lowest level" among the Global Fund's 22 donor countries. Sachs added that the U.S. has a "national responsibility" to fulfill its commitments to the Global Fund for addressing HIV, TB and malaria in developing countries (Inter Press Service, 1/29). Sachs also called on the U.S. to reclaim the "unbelievably egregious" $18 billion bonuses that some Wall Street bankers issued with recent government bailout funds and "put the money into the Global Fund immediately" ("Booster Shots," Los Angeles Times, 1/30).

According to Michel Sidibe, UNAIDS executive director, a decline in international commitments to address HIV, TB and malaria could create "a major, major problem in the future." Sidibe said that the global community "cannot abandon ... millions of people on treatment or break the hope of 12 million AIDS orphans." Sidibe added, "We need a fully funded Global Fund" (AFP/Google.com, 1/30). According to the Inter Press Service, HIV, TB and malaria cost Africa about $12 billion annually in lost productivity. "It's a case of lost opportunities, and it would be a huge mistake on the part of the world to write off this continent," Chernin said, adding that Africa has "enormous human capital, people willing to work hard and make major contributions to society." Gupta added that the Global Fund is "not asking for a bailout" but encouraging donor governments to "honor their previous commitments to spend this level of money for the world's health and prosperity." According to Gupta, a fully funded Global Fund could "save nearly two million additional lives in the coming years" (Inter Press Service, 1/29).

The Seattle Times "Business of Giving" blog reports that some private companies have announced contributions to the Global Fund, including a $30 million donation from Chevron and $150 million in funds from the (Product) Red campaign. In addition, Chernin on Friday launched a campaign with Exxon Mobil and Standard Charter Bank to raise $100 million from private companies, primarily for the Global Fund's malaria programs (Heim, "Business of Giving," Seattle Times, 1/29).

According to the Inter Press Service, the Global Fund provides about one-quarter of all international HIV/AIDS funding, about two-thirds of TB funding and about three-quarters of malaria funding. The organization has helped to provide antiretroviral drugs to two million people, TB drugs to 4.6 million people and 70 million insecticide-treated nets to prevent malaria. In addition, officials estimate that the Global Fund has helped to prevent 2.5 million deaths from these diseases, the Inter Press Service reports (Inter Press Service, 1/29). "All is not doom and gloom," Gupta said, adding that the Global Fund has "tremendous success to celebrate in global health, although we have a long way to go" ("Booster Shots," Los Angeles Times, 1/30).

Experts at Colorado TB Conference Discuss TB in Ethiopia, Drug-Resistant Strains

Scientists and advocates recently discussed the tuberculosis burden in Ethiopia and the increase in drug-resistant strains of the disease at the seventh Keystone Symposia Tuberculosis Series, which took place from Jan. 25 to Jan. 30 in Keystone, Colo., the Summit Daily News reports. About 635 people from 41 countries participated in the conference, which received support from the Bill & Melinda Gates Foundation.

According to Mulualem Agonafir Gadena, an Ethiopian TB researcher and technical coordinator, TB is the leading cause of mortality and the third most common reason for hospitalization in Ethiopia. About 50% to 60% of people who contract drug-resistant TB in the country die from the disease, the Daily News reports. Gadena added that sputum smear tests for diagnosing drug-resistant strains are 27% accurate in Ethiopia, compared with a rate of 88% in the U.S. In addition, the National Tuberculosis Reference Laboratory at the Ethiopian Health and Nutrition Institute is the only facility in Ethiopia that has the capability to diagnose drug-resistant TB. According to the Daily News, the country needs an additional four facilities with the capability (Allen, Summit Daily News, 1/30).


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