On February 4, the House passed legislation to concur with the Senate amendments to H.R. 2, State Children’s Health Insurance Program (SCHIP) Reauthorization by a vote of 290-135. Later that afternoon, President Obama signed the bill into law. This legislation reauthorizes and improves SCHIP. The Senate-passed version is very similar to the bill that the House passed on January 14 by a vote of 289-139. SCHIP was created in 1997 to provide health care coverage for children in modest-income families that earn too much for Medicaid, but not enough to afford private insurance. Over the last ten years, it has proven to be a successful and cost-effective program for providing health care.
The Gavel: House Sends State Children’s Health Insurance Program (SCHIP) Reauthorization Act To President>>
Speaker Pelosi: ‘Today is a Very Special Day for Us in the House; We Are Going to Help 11 Million Children’>>
Watch Speaker Pelosi speaking on the House floor in support of the bill:
The Children’s Health Insurance Program Reauthorization Act of 2009 is an updated version of the first bipartisan reauthorization bill vetoed by President Bush (H.R. 976). The legislation reauthorizes the SCHIP program through Fiscal Year 2013, providing sufficient federal funds to enable states to maintain their current programs and extend them to 4 million additional uninsured low-income children. The major change from the vetoed bill is the inclusion of an option for states to eliminate the 5-year waiting period for low-income uninsured children who are legally in the U.S.
President Obama strongly supports this SCHIP legislation, which provides a much-needed down-payment on children’s health. By extending health coverage to millions more children, this legislation is an important first step in stemming the rising tide of the uninsured.
Following is an overview of some of the bill’s key provisions, as amended by the Senate.
Ensures health care coverage for 11 million American children. The bill renews and improves the State Children’s Health Insurance Program (SCHIP), reauthorizing it for four and a half years – through FY 2013. The bill ensures that the roughly 7 million children who currently participate in SCHIP continue to receive coverage. It also extends coverage to 4.1 million uninsured children, according to the nonpartisan Congressional Budget Office.
Improves care and strengthens funding. The bill invests in new funding over the next four and a half years in SCHIP in order to strengthen SCHIP’s financing; increase health care coverage for low-income, uninsured children; and improve the quality of health care children receive.
Provides resources for states to reach uninsured children who are today eligible for SCHIP and Medicaid but not yet enrolled. 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, such as certain bonus payments and a new option for “Express Lane” enrollment, necessary to reach and cover millions of uninsured children who are eligible for, but not enrolled in, SCHIP and Medicaid.
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 children receive mental health services on par with the medical and surgical benefits covered under SCHIP.
Provides a new “dental wrap” benefit under SCHIP. As amended by the Senate, because private insurance coverage of dental care is often limited, states will have a new option to provide dental-only coverage to children who are otherwise insured to ensure access to dental services.
Prioritizes children’s coverage and phases out coverage of childless adults and parents. The bill phases out the coverage of childless adults and parents in SCHIP. (While the bill phases out the coverage of these adults, it also gives states a new option to cover pregnant women under SCHIP to ensure that babies get a healthy start.)
Improves the quality of care for low-income children. The bill establishes a new initiative to develop and implement pediatric health quality measures and improve state reporting of quality data.
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.
Targets efforts on enrolling the lowest-income children. Under the bill, bonus payments to states that enroll eligible but uninsured children are only paid for children who are newly enrolled in Medicaid, not SCHIP. Medicaid-eligible children are the lowest-income children in a state. The bill also ensures states focus on the lowest-income children by prohibiting states from receiving the higher SCHIP matching rate for any children covered in families with annual incomes above $54,930 for a family of three.
Improves access to private coverage options. The bill contains provisions designed to minimize children moving from private insurance to SCHIP. For example, it creates new options for states to develop and expand premium assistance programs, which allow states to use SCHIP and Medicaid funds to help subsidize employer-sponsored health care coverage for a child (thereby keeping a child in their parents’ employer-sponsored health plan.)
Ensures illegal immigrants do not receive coverage under SCHIP. The bill includes a provision explicitly reaffirming that nothing in the act allows for payments for individuals who are not legal residents. In addition, under current law, there is no citizenship documentation requirement for SCHIP. The bill requires, for the first time, that SCHIP programs comply with the citizenship and identity documentation requirements in Medicaid. To ensure that the citizenship documentation requirements are met, without discouraging enrollment of eligible citizen children, the legislation allows states the option to electronically verify citizenship and identity through the Social Security Administration. That provision includes all the modifications negotiated with House and Senate Republicans in 2007.
Gives states the option of ensuring certain legal immigrant children and pregnant women can access health coverage without delay. The bill gives states the option of covering legal immigrant children and pregnant women who have been here less than five years under SCHIP and Medicaid. The current five-year wait period can mean the difference between preventing or treating health conditions that can affect a child’s prospects for a healthy and productive life – or leaving those conditions undetected and not prevented, costing taxpayers much more in the long run. Similarly, a pregnant woman cannot wait five years for pre-natal care that will help her have a healthy baby.
Is fully paid-for – with an increase in the tobacco tax. The bill increases the federal excise tax on cigarettes by 62 cents a pack – from 39 cents to $1.01 – and also increases taxes on other tobacco products. Raising the tobacco tax discourages children from smoking – and polls show the public supports it as a way to pay for health care. According to the Campaign for Tobacco-Free Kids, an increase of 62-cents-a-pack in the cigarette tax means that nearly 1.9 million fewer children will take up smoking.
