HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Thursday, December 27, 2007

SCHIP Discussion and Realities

DailyKos has a full discussion about the recent veto of SCHIP expansion means for the children in various states.  DemFromCt reports,

. . . . I have been thinking about the state of play at the moment with SCHIP and where we go from here politically. This 12/20 summary is from

SCHIP Outlook

White House spokesperson Dana Perino in a statement said, "With this (SCHIP) bill, we can be assured that children will continue to have coverage, and Democrats won't be able to play election-year politics with children's health" (Neikirk, Chicago Tribune, 12/20).

The measure does not address an SCHIP policy directive announced in August by CMS that states must enroll 95% of children in families with incomes up to 250% of the federal poverty level before expanding eligibility, The Hill reports. Acting CMS Administrator Kerry Weems said that the Bush administration would not require states to disenroll children from the program despite the requirement. House Energy and Commerce Committee Chair John Dingell (D-Mich.) said that Weems' statement contradicts the policy, adding, "Perhaps CMS officials are reading their directive differently than the rest of us."

An analysis by the Georgetown University Health Policy Institute's Center for Children and Families found that 14 states provide SCHIP coverage to children in families with incomes greater than 250% of the poverty level and that they "will likely be forced to roll back their eligibility levels at some point before August 2008 or assume new coverage costs with state funds." Democratic Caucus Chair Rahm Emanuel (Ill.) on the House floor Wednesday said, "Because of the president's executive order, kids in those states will actually come off the rolls in August." The National Governors Association on Monday sent a letter to Congress asking it to "address the issue raised in the ... guidance issued by CMS" (Young, The Hill, 12/20).

[Rahm] Emanuel said SCHIP will be addressed this summer, when the new rules take effect. He said, "What we can't resolve, the American people will resolve in November," adding, "This will be the first thing a Democratic president will get done. We don't need March '09" (Johnson, CongressDaily, 12/19).

So, without defending (or piling on) the Democrats in Congress, who are having issues with caving on Iraq and perhaps a few other items, I would have been happier with more public votes. However, reality sometimes intrudes, and here are some realities:

Some states, at least, were running out of money. Georgia, for example:   The latest plan would extend funding for PeachCare and other programs like it around the country through March 2009 - a timeline first proposed by Rep. Nathan Deal, a Duluth Republican who took a leading role in previous negotiations on SCHIP.

The Baucus-Grassley measure would keep PeachCare funding at its current levels. But it would add additional funds to prevent Georgia and about 20 other states from running out of money early - a problem that this year forced Georgia lawmakers to freeze and cap enrollment for the state’s eligible children...

"With appropriate funding," she said, "children already enrolled and eligible for PeachCare can continue without interruption of their health care."

Since Oct. 1, PeachCare has been operating under month-long - and, in the latest case, weeklong - extensions of its current funding, leaving Georgia officials worried about running out of money in early 2008.

While it made political sense to fight up to the edge, Georgia went over the edge 10/1 and could not enroll new children (who, despite government caps,  have a habit of piling up when you are not paying attention). . . .

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