An analysis of the failed attempt to expand the State Children's Health Insurance Plan: A view from Capitol Hill

After ten years of experience, state and national public health leaders, state and federal elected officials, and democrats and republicans alike agreed the State Children's Health Insurance Plan (SCHIP aka CHIP), successfully provided health insurance for uninsured children and pregnant women. During six years of its reign, the current administration approved waivers to individual states already covering SCHIP-eligible children through Medicaid. These waivers allowed states to cover children at higher income levels, some parents, and other uninsured individuals. The Senate and House worked independently on SCHIP reauthorization. The Senate negotiated a bipartisan bill for the reauthorization, paid for by tobacco taxes, which passed with a veto-proof majority. This bill would have expanded the number of children covered under both CHIP and Medicaid. The House version included similar expansions and changes to Medicare – all financed through changes in Medicare Advantage plus a smaller tobacco tax. Select members of the House and Senate negotiated a common bill. With overwhelming bipartisan support and the support of over 40 governors, many were perplexed when the President threatened to and subsequently did veto SCHIP reauthorization - not once but twice. In order to avoid state shortfalls and disenrollment of children, Congress was forced to include a smaller SCHIP package in a continuing resolution. Two Robert Wood Johnson Health Policy Fellows who worked on SCHIP, one in the House and one in the Senate, analyze the players, the politics, external influences, and the financing of SCHIP. They also look at possibilities for SCHIP's political future.