I’d been only sort of following the SCHIP battle between Congress and the White House, and I thought others might be like me, so I took some time to sort through the news and speeches to try to nail a few key facts and debate points.

What is SCHIP? The State Children’s Health Insurance Program was enacted in 1997 as a way to provide health coverage for uninsured children whose families do not qualify for Medicare. The SCHIP programs are jointly financed by federal and state governments, but administered by the states, within broad federal guidelines. Currently, uninsured children in families with incomes at twice the federal poverty level or less - $36,200 a year for a family of four - are eligible for SCHIP coverage. 6.6 million children are currently covered under SCHIP, which is up for refunding.

What is the new SCHIP bill? The House and Senate have passed a compromise bill that would increase funding for SCHIP by $35 billion over the next five years (which would bring the total funding to $60 billion), with the goal of reaching roughly an additional 4 million uninsured children (around 9 million US children are currently uninsured). Uninsured families earning up to 300% of the federal poverty level - $61,842 for a family of four - would be eligible to apply for coverage for their children. States could apply for waivers to cover families earning more than this amount in certain cases; such waivers would be subject to the approval of the Secretary of Health and Human Services. The new bill phases out waivers that have allowed states to offer SCHIP coverage to some adults, but does allow for coverage for pregnant women. Dental and mental health benefits are included in the new proposal.

The expansion would be funded through an increase in the federal tobacco tax.

Criticisms and Counter-arguments

Point: The President recently told reporters: “I believe this is a step toward federalization of health care…Their proposal is beyond the scope of the program, and that’s why I’m going to veto the bill.”

Counterpoint: Senator Orin Hatch (R-Nebraska) argued that the compromise bill would cover 3.7 million of the 6 million uninsured US children from families with incomes of 200% of the federal poverty level or less, which “really goes to the heart of what we are trying to achieve” with the program as enacted in 1997.

Point: This bill would give families of four earning over $80,000 access to SCHIP funds.

Counterpoint: This is a talking point I’ve read in several places. Senator Hatch’s rebuttal: “Let me be clear. Our legislation does not permit a state to cover these families unless the Secretary of Health and Human Services approves the state’s application to cover individuals at that income level.” New York’s application for a waiver to cover uninsured children from families earning 400% above the poverty level has so far been denied.

Point: The program would entice families to move from private health insurance onto government programs.

Counterpoint: Senator Hatch argues that the SCHIP bill includes funding incentives and specific guidelines to help states focus their enrollment efforts on low-income, uninsured families. However, the Congressional Budget Office does project that while 3.7 million of new enrollees will have been previously uninsured, about 2 million children will likely be moved by their parents from private coverage to SCHIP.

Point: It’s unfair to increase the tax burden on smokers.

Counterpoint: Cigarette taxes offer a disincentive for smoking, and have been shown to cut teen cigarette use.

Point: The program is expensive.

Counterpoint: Uninsured kids tend to receive medical treatment in emergency rooms, which winds up costing taxpayers more that the SCHIP program would. Also, as a comparison, over the next five years we’ll spend $2.6 trillion dollars for Medicare.

My take, for what it’s worth: It was nice to read Senator Hatch’s address, dry, boring, and completely removed from the screeching rhetoric that has colored much of the SCHIP debate. I tend to trust his assessment. This may not be a perfect bill - there may be some misuse of the program that will have to be addressed, and as a former smoker, I do feel for those who are going to get hit with yet another tax - but it looks to me like the two parties have hammered out a good compromise bill that should address one serious piece of our current health care crisis.

However, that figure of 2 million children being moved by their parents from private to public insurance does concern me. Back to Senator Hatch: “I will not sugar coat it. It is a problem. It is a concern. And, we should take every step we can to keep it from occurring.” I’d like to hear some specifics there.

For a different perspective, George Will has a Newsweek column up about the politics of the debate and how it frames the future of health care, which is interesting, but includes the inaccurate talking point that families earning $83,000 would automatically be eligible to apply for SCHIP.

Feel free to weigh in, as always.

Posted by MommaSteph.