Children's Health: CHIP Reauthorization 2007
New to the State Children's Health Insurance Program (CHIP)? Need a refresher on exactly what happened during the 2007 CHIP reauthorization debate? You can find a play-by-play summary and links to the bills, votes, and other relevant documents below.
December 21:
Congress Extends CHIP Program until March 2009
After two presidential vetoes and days before the program was scheduled to run out, Congress extended the CHIP program until March 2009. This time, the President plans to sign the bill. The legislation includes just enough money to sustain the program at its current level and keep the approximately 6 million children in CHIP from losing their health coverage. Unfortunately, there is no funding to cover uninsured children who are eligible for the program but not enrolled.
The extension was contained in a large health care bill called the Medicare, Medicaid and SCHIP Extension Act of 2007. Taken as a whole, this bill is both a disappointment and a promise for more health care action next year. For example, the bill does not address the Administration's harmful directive to limit CHIP eligibility to families who make less than 250 percent of the federal poverty level. Overturning this wrong-headed policy will be a top goal in 2008.
There is some good news in the bill: It does not contain harmful CHIP policy changes that opponents of the program wanted. This means that states that have covered low-income, uninsured adults using CHIP funds can still do so. And the onerous citizenship documentation requirement in Medicaid was kept out of CHIP. The bill also temporarily blocks bad Medicaid regulations that deny rehabilitative and school-based services for low-income people who depend on them.
Still, we didn't get nearly as far as we could have. Congress twice passed a bill—with strong bipartisan support—to cover 10 million low-income children. The President vetoed it twice.
The vote to overturn the President's second veto is scheduled to take place in the House of Representatives on January 23. If the vote fails, this extension will stay in place. This vote is a great opportunity to make sure our Representatives hear from their constituents!
The opportunity to cover more kids is not lost, but it has been delayed by this President and his allies in Congress. In the meantime, millions of uninsured children will remain uninsured.
Next year, we will need your help to make sure the decision by the President and his friends to deny health coverage for millions of low-income American children comes up over and over again.
November 13:
Congress Readies Second Continuing Resolution as CHIP Negotiations Continue
Despite both the House and Senate having passed a revised version of CHIPRA several weeks ago, the House still lacks the votes needed to override an inevitable Presidential veto of the bill, so negotiations among a select group of members continue. The original authorization of CHIP expired at the end of September. Since then, the program has been operating under a six-week extension, with states getting the same amount of money they received for the program last year. That extension expires at midnight on November 15. Recognizing that they are unlikely to reach a compromise before then, Congress included a second CHIP extension in its continuing resolution for federal spending. That extension would expire on December 14. The President is expected to sign the second continuing resolution.
October 25:
Senate Passes Revised CHIP Bill with Bipartisan Support, 64-30
Following passage in the House on October 25, the Senate voted on the revised version of the CHIP bill and, once again, passed it with strong bipartisan support. Among those voting, all members who voted for the original CHIP bill also voted for the revised version. To see how your Senators voted, click here.
Bipartisan negotiations between key members continue, and in the coming weeks, a compromise may still be reached that would garner enough Republican votes to pass the bill by a veto-proof majority. There are not immediate plans to send the passed bill to the White House. Stay tuned for updates.
For the full text of the bill, click here, and Families USA has also updated our quick summary side-by-side.
Highlights of the revised bill:
- It still allows 10 million children to be covered over the next five years, at a cost of $35 billion.
- New income restriction: For the first time in the history of CHIP, states will not be permitted to cover children with incomes above 300 percent of poverty.
- Improved targeting of poor children: The legislation increases bonuses to states that enroll more Medicaid-eligible children and cancels bonuses for additional enrollment of CHIP-eligible children.
- Gets adults off CHIP faster: The revised bill phases out waiver coverage of childless adults in one year (rather than two years, as under the original legislation).
- New crowd-out requirement: All states will be required to develop plans to reduce "crowd-out" (families leaving private coverage for CHIP). The original compromise required this only for states covering children with family incomes above 300 percent of poverty.
- Concrete changes to the citizenship documentation requirement: In response to Republican complaints about a lack of enforcement, the bill adds specific language, with an enforcement mechanism, to assure that no federal dollars will be spent on undocumented immigrants
October 18:
House Override Vote Failed by Small Margin (273-156)
Although the House fell just a few votes short of the two-thirds margin needed to override the President's veto of the bipartisan CHIP compromise bill, it was a close vote (check our Wall of Shame/Wall of Fame to see how your member voted), and our fight to bring health coverage to 10 million American children is not over.
Your actions made a difference! Everything you've done all year long to fight for health care for millions of low-income children has brought us this far. We are confident that we will secure a victory for children!
As we regroup and figure out next steps, take a moment to thank your member if he or she voted for the override, or make sure they hear your disapproval if they stood with the President and Big Tobacco—and against children. Stay tuned for new action steps in the coming days.
September 28:
It has been a pivotal week in the world of CHIP! On Tuesday night, the House passed the CHIP reauthorization bill with 265 votes and bipartisan support, but not quite a veto-proof margin. (To see how your Representative voted, click here.) Then, on Thursday night, the Senate also voted overwhelmingly in favor of the bill. Eighteen Republicans joined with all the Democrats to pass the bill, 67 to 29. (To see how your Senators voted, click here.)
Now, the bill heads to the President, who will have to decide whether to uphold his many threats to veto it. He can sign or veto the bill any time in the next two weeks. Assuming he does veto it, the bill returns to the House, which can override the veto if it musters 286 votes. So, now it's time to turn up the heat on the House and encourage as many members as possible to vote to override the veto. Call your Representative now to thank them for their support, or express your disappointment, and encourage them to vote in favor of the override (should that be necessary).
While all this was going on this week, the House and Senate also approved a six-week extension of CHIP at 2007 funding levels as part of a continuing resolution. So CHIP continues, at least until mid-November, albeit at limited funding levels.
September 24:
Members of Congress worked around the clock last week to come to an agreement on a final CHIP reauthorization bill. They have released a summary of this agreement, and the legislative language should be available soon. A House vote is expected Tuesday, with a Senate vote to follow on Thursday. Whether the President will follow through on his continued threats to veto the bill remains to be seen.
The agreement does take steps to replace the August 17 CMS CHIP crowd-out directive with new tools and assistance for states to prevent crowd-out, although the details are not yet available. For more information on this directive, click here.
Finally, there are some new resources available on children's coverage and the CHIP reauthorization bills that we thought you should know about:
- From The Urban Institute, How Will Low-Income Kids Benefit under House and Senate Bills? shows that both the House and Senate reauthorization bills would cover mostly children from the lower end of the income range: in both bills, more than three-quarters have incomes below 200 percent of poverty.
- From the Kaiser Commission on Medicaid and the Uninsured, What Happened to the Insurance Coverage of Children and Adults in 2006? shows that almost half of uninsured children have incomes between 200 and 399 percent of poverty—the very group the Administration is trying to shut out of CHIP eligibility in its crowd-out guidance. The report also found that the number of uninsured kids grew much more dramatically among the 200-399 percent of poverty group than among lower-income children, who are more likely to be eligible for Medicaid and CHIP.
September 20:
At a news conference held September 20, President Bush reiterated his threat to veto the CHIP bill that comes out of the conference committee. This would be a huge blow to the bipartisan effort put forth by Congress, and to millions of American children who are counting on CHIP for health coverage.
Senator Grassley (R-Iowa), ranking member of the Committee on Finance, has released comments that express his disappointment in the President’s decision to veto. Senator Hatch (R-Utah), when asked if he would vote to override a veto, said, “You bet your sweet bippy I will.”
August 3:
Thanks in large part to your efforts, the House and the Senate have passed bills to reauthorize CHIP, the Children's Health Insurance Program. The House version of the bill (the CHAMP Act) provided more funding than the Senate version, with $50 billion over five years funded by raising the federal tobacco tax by 45 cents and phasing out overpayments to private managed care plans in Medicare. The Senate bill increased spending by only $35 billion over five years, funded by raising the federal tobacco tax by 61 cents, but the bill was able to garner a veto-proof majority with 68 Senators—Democrats and Republicans—voting in our favor. See Families USA's updated side-by-side for more details on how the two bills compare.
Now, we are one step closer to reauthorizing this critical program for millions of children. Come September, the House and Senate bills will be reconciled in conference committee. Then the bill goes to President Bush for his signature—or a veto.
But before we get ahead of ourselves, there are 293 legislators that deserve to be thanked for their vote for children's health. Please click here to see how your Senators voted, click here to see how your Representative voted, and call 1-800-828-0498.
While Congress is on its August recess, we are preparing for the final push to reauthorize CHIP. Now that the power of the grassroots is clear, we will be counting on your support more than ever. But first, take a minute to congratulate yourself and your legislators.
July 31: Key Senate and House Votes Expected This Week
This is it! The week we have all been working toward for the last several months: Both the Senate and House kick into high gear this week on SCHIP, with floor votes in both chambers before the week is out. Last night, the Senate voted 80-0 to open debate, which will continue throughout the week. The House is scheduled to vote on its version of the bill on Wednesday, August 1.
Senate
We expect to see several amendments offered in the Senate, many of which would weaken the carefully constructed, bipartisan Senate Finance Committee bill (the Children's Health Insurance Program Reauthorization Act of 2007). One of the most harmful bills will be offered by Senator McConnell (R-KY) and is misnamed the "Kids First Act." Families USA has prepared talking points describing how this bill would harm low-income children. Voting on amendments is expected to start as early as this afternoon and to continue for the next few days.
House
The House version of the bill, the Children's Health and Medicare Protection (CHAMP) Act, overcame several procedural and technical hurdles late last week and is expected to arrive on the floor virtually the same as proposed in committee. The vote on the House floor could be close, primarily because the tobacco and insurance companies have been mounting an active campaign to oppose the financing mechanism in the bill (an increased tobacco tax and cuts to certain private insurance plans in Medicare). On Wednesday, August 1, there will be intense debate on the House floor, followed by a vote on the bill.
July 24: House Energy & Commerce Committee Releases CHIP Bill
The House has started to move on CHIP, releasing Chairman Dingell's mark in the wee hours of the night on July 24th. We commend the committee leadership for writing a strong reauthorization bill that includes the full $50 billion for the program, expands Medicaid and CHIP to legal immigrant children and pregnant women (ICHIA), includes incentives to streamline outreach and enrollment, and many other great policies that will go a long way toward strengthening and improving the program. The bill achieves the full $50 billion for children mainly by increasing the federal tobacco tax by 45-cents and ending overpayments to some private insurers in Medicare. The Energy & Commerce mark-up is scheduled for this morning, with the Ways & Means Committee following close behind in the afternoon.
Families USA has prepared a side-by-side comparing the CHIP components of the Senate and House bills. While the Senate bill focuses only on Medicaid and CHIP, the House bill also contains significant improvements to Medicare and eliminates scheduled cuts to provider payments.
In the meantime, Congressmen Barton and Deal have countered Chairman Dingell's CHIP reauthorization bill with a Republic alternative that would cause millions of children to lose or be denied coverage over the next five years. Families USA has prepared some talking points explaining why this bill would be harmful to low-income children.
July 19: Senate Finance Committee Passes CHIP Proposal
The Senate Finance Committee finished the markup of the SCHIP proposal at noon today, passing it soundly. All of the Democratic members and six of the Republican members (Grassley, Hatch, Snowe, Smith, Crapo, and Roberts) voted for passage. Voting no were, not surprisingly, Lott, Kyl, Ensign and Bunning.
All of the amendments that went to a vote would have weakened the bill except one (offered by Senator Salazar to improve CHIP payments to federally qualified health centers), and we're happy to report that all of the potentially bad amendments failed. They included policies such as allowing premium assistance to be used to purchase high-deductible plans and restricting CHIP eligibility to 300 percent of poverty. Several other members offered amendments that would have strengthened the bill (like increasing the funding to $50 billion and adding ICHIA), but these were withdrawn before a vote, largely because they were unlikely to pass. However, several improvements were added to the proposal before today's markup (through managerial modifications), including an Express Lane state demonstration program, mental health parity in CHIP, and dental health grants. Click here for the modified mark. Click here for Families USA's quick summary of the proposal the committee passed.
Thanks to everyone for your continued hard work on this issue, and be sure to thank your members for all their hard work on CHIP so far. Today's vote takes us one step closer to better health care for millions of children! Stay tuned for more information about a floor vote in the Senate, as well as the House's SCHIP proposal (due out any day now).
July 13: Senate Finance Committee Chairman's Mark
On July 13, at long last, the Senate Finance Committee released a bipartisan Chairman's Mark on SCHIP reauthorization. Families USA has prepared a quick summary of the bill for those of you who don't want to wade through all 50+ pages. We applaud the progress that Senators Baucus, Grassley, Rockefeller, and Hatch have made in coming together to support the reauthorization of SCHIP. The bill includes some very important policies that would help strengthen children's health coverage. However, it also has some serious shortcomings that we will work to correct in the coming days and weeks. Click here for a copy of Families USA's press statement about the mark. The committee is scheduled to mark up the bill tomorrow (July 19), so there may be some changes to it before it hits the Senate floor, depending on the outcome of various amendments. We'll update our summary as necessary. We hope to see a floor vote in the Senate, as well as committee and floor votes in the House, before the congressional recess in August.
In a related matter across town, the Administration is ratcheting up its opposition to SCHIP reauthorization, most recently with a letter yesterday from HHS Secretary Leavitt to Senators Baucus and Grassley criticizing the bipartisan Chairman's Mark and officially offering President Bush's veto threat. Senator Baucus quickly issued a response, repeating his call for the Administration to join with members of Congress from both sides of the aisle, as well as the American public, who want more low-income children to have the health care they deserve.
July 10: Bipartisan Agreement Reached
On July 10, the Senate Finance Committee announced that it had tentatively reached a bipartisan agreement on SCHIP. The announcement is noteworthy because it retains the SCHIP program's tradition of bipartisanship -- a tradition that dates back to the program's inception in 1997. The deal includes $35 billion in new funding, which will be primarily offset by an increase in the federal cigarette tax. More details about the bill will be available on Friday in advance of the markup, which is scheduled for Tuesday, July 17.
June 27: President Continues to Speak out against Full Funding for SCHIP
In a statement this week, the President emphasized his proposal for SCHIP reauthorization, which adds a meager $4.9 billion to the program over the next five years, and reiterated his belief that the program be limited to children with family income below twice the poverty level. His proposal would only increase the number of uninsured children. Leading Democrats quickly issued responses to the President's statement:
June 21: Senator Baucus Questions HHS Study on SCHIP
The Department of Health and Human Services (HHS) released a study on June 18 that claimed that far fewer uninsured children are eligible for Medicaid and SCHIP than were previously believed. The study flies in the face of all other evidence, which shows that about two-thirds of uninsured children are eligible for Medicaid or SCHIP, and it is likely part of a larger plan to halt a fully-funded SCHIP reauthorization in favor of the Administration's woefully inadequate reauthorization proposal. Read Senate Finance Committee Chairman Baucus's statement questioning the study and his letter to HHS Secretary Leavitt by clicking here.
June 6: Hatch and Kennedy SCHIP Reauthorization Principles
Senators Hatch (R-UT) and Kennedy (D-MA), two of the authors of the original SCHIP legislation, released principles for SCHIP reauthorization last week (June 6). These principles support many of the things Families USA hopes to see in reauthorization, including sufficient federal funding to cover uninsured children who are eligible for SCHIP; incentives for states to simplify outreach, enrollment, and renewal policies; state flexibility with respect to eligibility levels; ICHIA; and increasing the federal tobacco tax to pay for increased SCHIP funding.
Hill Update
The SCHIP reauthorization debate is in full swing in Washington. After an encouraging budget resolution that includes $50 billion in new federal funding for SCHIP, the summer months are expected to bring serious committee debate and floor action in both the Senate and the House. The Senate Finance Committee was expected to mark up SCHIP legislation in June, but for reasons likely related to both policy and politics, the mark up has been delayed until after the Fourth of July recess. The House Energy and Commerce Committee will also likely mark up SCHIP legislation in July.
Goings On
A number of sign-on letters have circulated recently about the Immigrant Children's Health Improvement Act (ICHIA), citizenship documentation, and increasing the federal tobacco tax to offset the new money needed for SCHIP. Find these here.
SCHIP Bills
A number of SCHIP reauthorization bills have been introduced over the past few months (Rockefeller-Snowe, Clinton-Dingell, Durbin, Emanuel). While each of these bills includes good policy for children’s health coverage that we hope will make it into law, the most important thing for advocates to focus on now is the Chairman’s “mark” (the Chairman’s version of the bill) in the Senate Finance Committee and the Senate floor vote to follow (expected in June). Then, the Chairman’s “mark” in the Energy and Commerce Committee in the House, with a House floor vote to follow, is expected in July. These committee “marks” will be the basis for the SCHIP reauthorization legislation. We’ll let you know as soon as we know more about what’s included in these “marks.”
May 25: 2007 SCHIP Shortfall Fix
Good news! The Iraq supplemental spending bill (H.R. 2206) signed by the President on May 25 included $650 million to fill states’ SCHIP shortfalls through the end of the fiscal year (September 30, 2007). This is only a Band-Aid to get states through the year, though. Without new federal funding for SCHIP in reauthorization, many states will be right back where they started this year with significant shortfalls in fiscal year 2008.
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