On October 25, the House passed a revised version of this bill, which once again provides 10 million American children with health care while meeting certain concerns that have been raised. This revised bill was again vetoed by the President on December 12.
SCHIP provides health coverage to American children whose parents do not qualify for Medicaid, but can not afford private insurance. This bill would bring health coverage to approximately ten million children in need – preserving coverage for all 6.6 million children currently covered by SCHIP, and reaching millions more low-income, uninsured American children in the next five years.
Watch Speaker Pelosi's statement in support of the revised legislation:
The bipartisan bill that the President vetoed had included several provisions that were designed to ensure that: 1) the focus would be enrolling low-income children in SCHIP first; 2) SCHIP would not cover illegal immigrants; 3) SCHIP coverage of adults would be phased out; and 4) children leaving private insurance for SCHIP would be minimized.
However, concerns have been raised in all four of these areas. Therefore, the revised bill includes provisions to meet these concerns.
The revised bill further clarifies that the legislation is targeted on enrolling low-income children first:
- SCHIP coverage will be capped at 300 percent of poverty.
- States will only receive bonus payments for enrolling eligible children in Medicaid, the lowest income children in a state.
The revised bill further clarifies that the legislation does not allow illegal immigrants to get SCHIP:
- If the Social Security Administration cannot confirm an applicant’s citizenship, the applicant will be required to provide the state with additional documentation to confirm eligibility.
The revised bill further clarifies that the legislation is focused on prioritizing children’s coverage and phasing out adults:
- Whereas under the original bill, childless adults are phased out over two years, under the revised bill they are phased out over one year.
The revised bill also further clarifies that the legislation is designed to minimize children moving from private insurance to SCHIP (known as “crowd-out”):
- All states will be required to develop plans and implement recommended best practices for minimizing “crowd-out.”
- Premium assistance programs (using SCHIP funds to help subsidize employer-sponsored health coverage for a child) are added to the list of things a state can do to get bonus payments.
Invests $35 billion in new funding for SCHIP. The bill reauthorizes the Children’s Health Insurance Program, investing an additional $35 billion over five years to strengthen SCHIP’s financing; increase health care coverage for low-income, uninsured children; and improve the quality of health care children receive. As Republican Senator Grassley has pointed out, “As far as the size of the package, it’s important to understand that about half of the new money is needed just to keep the program running, and the rest goes to cover more low-income kids.”
Ensures health care coverage for more than 10 million American children. First, the bill ensures that the 6.6 million children who currently participate in SCHIP continue to receive health care coverage. It also extends coverage to 3.8 million children who are currently uninsured, according to the nonpartisan Congressional Budget Office.
Does not “expand" SCHIP; simply provides for enrolling children who are currently eligible but not yet enrolled. Despite claims by President Bush, this bill does nothing to “expand” the SCHIP program; this bill maintains current law regarding children’s eligibility for SCHIP. Two-thirds of uninsured children are currently eligible for coverage through SCHIP or Medicaid – but better outreach and adequate funding are needed to identify and enroll them. This bill gives states the resources and incentives necessary to reach millions of uninsured children who are eligible for, but not enrolled in, the program.
Targets lowest-income uninsured children for outreach and enrollment. The bill is designed to target specifically the lowest-income uninsured children for outreach and enrollment in SCHIP coverage. The bill does NOT call for SCHIP coverage for children in families at higher income levels. Instead, it reduces federal matching funds for future coverage of children at higher income levels, and provides incentives to cover the lowest-income children instead.
Improves SCHIP benefits -- ensuring dental coverage and mental health parity. Under the bill, quality dental coverage will now be provided to all children enrolled in SCHIP. The bill also ensures that states will offer mental health services on par with medical and surgical benefits covered under SCHIP.
Provides states incentives to enroll uninsured low-income children. The bill provides incentives for states to lower the rate of uninsured children by enrolling eligible children in SCHIP and Medicaid, including providing bonus payments. States will receive state-based allotments that are responsive to state demographic and national spending trends. States that face a funding shortfall and meet enrollment goals will receive an adjustment payment to ensure that no child who is eligible for Medicaid or SCHIP is denied coverage or placed on a waiting list.
Replaces CMS August 17th letter to the states. On August 17, the Center for Medicare and Medicaid Services (CMS) sent a letter to the states drastically changing federal policy and placing unrealistic conditions on the ability of states to cover children above 250 percent of poverty. This bill replaces that letter. First, the bill states that it agrees with the President on the importance of ensuring that low-income children have health coverage and taking steps to address substitution of private coverage. Secondly, the bill replaces the letter with a more appropriate approach. In place of the letter, the bill gives states time and assistance in developing and implementing best practices to address substitution of coverage. The bill also puts the lowest-income children first in line by phasing in a new requirement for coverage of low-income children as a condition of receiving SCHIP funding for coverage of children above 300 percent of poverty.
Improves outreach tools to streamline enrollment of eligible children. The bill provides $100 million in grants for new outreach activities to states, local governments, schools, community-based organizations, safety-net providers and others.
Improves the quality of health care for low-income children. The bill establishes a new quality child health initiative to develop and implement quality measures and improve state reporting of quality data.
Prioritizes children’s coverage. The bill contains provisions to phase out the coverage of parents and childless adults in SCHIP. However, it provides coverage of pregnant women as a new state option as well as preserving the options to cover pregnant women through a state waiver or through regulation.
Is fully paid for – by raising the tobacco tax by 61 cents a pack. The higher the cost of cigarettes, the less likely kids will take up smoking. According to the Campaign for Tobacco-Free Kids, a 61-cent increase in the tobacco tax means that 1,873,000 fewer children will take up smoking.
