Bill would maintain existing SCHIP coverage, allow for more enrollees

The central tenet of medicine is to first do no harm.  The State Children’s Health Insurance Program (SCHIP) is one federal program that works, and works well.  For over a decade, it’s been providing health care coverage to one of our most vulnerable populations — our children.

Just last week, as part of the 2008 budget debate, Congress included an unprecedented $50 billion for SCHIP reauthorization. This funding amount means that healthcare for our nation’s children and families is a priority again.  It also means that we take very seriously our responsibility to reduce the ranks of the uninsured and fulfill our moral obligation to our most vulnerable citizens.

There is no question that providing health care coverage for children enjoys broad, bipartisan support.

However, as the Senate moves forward with this debate, concerns are being raised that SCHIP has exceeded its original mandate, and now includes waivers permitting health care coverage for uninsured adults and family members — including pregnant women and parents of eligible children.  However, some of my colleagues want to give these SCHIP waivers a second opinion and their prescription for a cure would actually do more harm than good.

SCHIP was born out of the health care debates in the early 1990’s after efforts to provide comprehensive health insurance failed to take hold.  These waivers were intended to be part and parcel of the preferred incremental prescription to cure our uninsured woes.  
There is explicit authorization in the SCHIP statute for the Secretary of Health and Human Services to grant SCHIP waivers to provide family coverage. Each Secretary since the creation of SCHIP — in both the Clinton and Bush administrations — has enthusiastically used this authority. It was understood then, as it is now, that parent coverage furthers the goals of SCHIP. 

A child whose parent has health insurance coverage is more likely to receive health care and use preventative health services, such as dental exams and immunizations. Conversely, having an uninsured parent not only decreases the likelihood that a child will have a well-child visit; it also decreases the likelihood that a child will see any medical provider at all.  

Recently, some at HHS and in Congress have feigned shock over the discovery that in some states, SCHIP allows coverage for both children and their parents. This is especially perplexing because, for the last six years, the Bush Administration administration has encouraged states to cover parents, and has lauded such coverage flexibility as a way to reduce the growing numbers of uninsured. 

At a July 25, 2006, Finance Committee hearing on SCHIP, former CMS Administratoradministrator,  and Bush appointee,  Mark McClellan stated, “Extending coverage to parents and caretaker relatives not only serves to cover additional insured individuals, but it may also increase the likelihood that they will take the steps necessary to enroll their children. Extending coverage to parents and caretakers may also increase the likelihood that their children remain enrolled in SCHIP.” I agree, but now many in Congress want to take away that coverage.

It is a false choice to suggest that in order to improve coverage for children enrolled in SCHIP that we must simultaneously reduce or eliminate coverage for their parents.  In fact, we know that the opposite is true — reducing SCHIP coverage for parents and pregnant women will limit coverage for their children. 

Moreover, shutting down existing parent coverage will only add to the number of uninsured, and will do little to solve SCHIP’s funding crisis.  In fiscal year 2005, only 638,789 pregnant women and parents were covered with SCHIP funds compared to more than 6.1 million children.  One thing is clear, SCHIP reauthorization should not result in more Americans becoming uninsured. 

That’s why I’ve drafted legislation that will maintain coverage for the 6.6 million children enrolled in SCHIP, while providing states the resources necessary to expand their programs to the 6 million children who are eligible, but unenrolled.  In addition, this legislation would improve the SCHIP funding formula and target federal dollars to those states that are doing the most to cover children.  This legislation would end, once and for all, the chronic shortfalls that have historically accompanied SCHIP funding year after year.

Ten years ago, Congress stepped up to the plate to meet the needs of our children.  It’s time to do that again.  As we work to make good on that promise, let us reauthorize SCHIP and ensure that it has the federal funding it needs to carry on its important mission.

Rockefeller is chairman of the Subcommittee on Health Care of the Senate Finance Committee.


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