The SCHIP Standoff
GAO says Bush administration's directive on SCHIP violates federal law - Updated 4.21.08
The New York Times (4/19, A10, Pear) reported that in an opinion issued on Friday, lawyers from the Government Accountability Office (GAO) said that the restrictions to the State Children's Health Insurance Program (SCHIP) put in place by the Bush administration last year "violated federal law." The enrollment requirements "restricted states' ability to provide health insurance to children of middle-income families, and its new policy is therefore unenforceable," the GAO stated. The "accountability office said the new policy 'amounts to a marked departure' from a longstanding, settled interpretation of federal law."
The GAO "advised Sen. Jay Rockefeller (D-W.Va.) that the administration's policy changes amounted to a rule," and, under the Congressional Review Act, it "should have been submitted to Congress and the comptroller general before going into effect," the AP (4/19) explained. Instead, the administration "sent a letter to state health officials informing them of the changes they were making to the program, which it described as a clarification of existing law."
According to The Hill (4/19, Young), "Several states are suing the federal government over the directive, making similar claims that it was unlawfully put in place." Shortly after the Centers for Medicare and Medicaid Services (CMS) adopted "the policies, one state, New York, had its application rejected to expand SCHIP to children of families with incomes above 400 percent of the federal poverty level." The main issue of contention regarding the "directive is that CMS would deny any application to expand enrollment to children of families with incomes exceeding 250 percent of the federal poverty level, unless that state could certify [that] it had already signed up at least 95 percent of children living in households with incomes below 200 percent of poverty." Many of the states "assert this threshold is nearly impossible to meet, though the administration disputes this."
While the "GAO cannot require the CMS to pull back the order," Sen. Rockefeller "has introduced legislation that would effectively stop the directive from being implemented," Modern Healthcare (4/19, DoBias) noted. Sen. Rockefeller said, "The directive is a bold-faced attempt to subvert the law, and prevent states from implementing their plans to provide health insurance coverage to millions of uninsured children nationwide."
U.S. House unable to override SCHIP veto - Updated 1.24.08
In continuing coverage from previous briefings, the (1/24, A18, Pear) reports that in a 260-to-152 vote on Wednesday, the U.S. "House sustained President Bush's veto of" the State Children's Health Insurance Program (SCHIP) "bill to provide coverage to nearly four million more uninsured children." Proponents of the bill "were 15 votes short of the two-thirds majority needed to pass the measure over the President's objections." The measure would have added "$35 billion to the child health program, providing a total of $60 billion over the next five years," and "allow[ed] states to cover nearly four million children, in addition to the six million already on the rolls."
According to the (1/24, A4, Lee), "Forty-two Republicans supported the override attempt, two fewer than in the previous effort to reject Bush's Oct. 3 veto of an earlier version of the bill." Citing last month's congressional approval of additional funding, Republicans also noted that SCHIP now has enough funding to maintain its current levels through March 2009. Meanwhile, Democratic members of Congress "argued that the nation's economic troubles made expanding a program that provides subsidized health insurance to children of the working poor all the more important."
Updated 12.27.07
The Senate passed by voice vote a "bare bones" legislation that replaces the 10.1 percent scheduled cut in the Medicare physician fee schedule with a six-month 0.5 percent positive update (through June 2008). The legislation will also extend funding for the SCHIP program through March 2009. Click here for a summary of the legislation. The House is expected to pass the measure without any changes, and the President is expected to sign the bill.
Updated 12.19.07
The House has passed S. 2499, the Medicare, Medicaid and SCHIP Extension Act of 2007 by a vote of 411 to 3.
President Bush vetoes SCHIP again - Updated 12.13.07
The New York Times (12/13, Stolberg) reports that "President Bush vetoed" the State Children's Health Insurance Program (SCHIP) bill "on Wednesday afternoon, effectively killing Democrats' hopes of expanding a popular government program aimed at providing insurance to children in lower-income and middle-income families."
Failing to approve an additional $35 billion, the Washington Post (12/13, A18, Lee) reports that "Bush cited the same reasons that led him to veto a version of the bill on Oct. 3 -- that it raised cigarette taxes and provided coverage for children of middle-class families, instead of focusing on the working poor."
The AP (12/13, Loven) quotes President Bush as saying that "our nation's goal should be to move children who have no health insurance to private coverage, not to move children who already have private health insurance to government coverage." After providing his "seventh veto in seven years," President Bush continued to urge "Congress to extend the program at its current funding level before lawmakers leave Washington for their holiday break."
(Source: AMA Morning Rounds)
Medicaid eligibility issue may hinder SCHIP compromise - Updated 11.19.07
Congressional Quarterly (11/17, Wayne, Staff) reported, "A dispute over Medicaid eligibility is now the primary obstacle to a deal on" SCHIP, according to lawmakers. The issues was initially raised by House Republicans, who "appear to have won two important allies in Sens. Orrin G. Hatch (R-Utah) and Charles E. Grassley (R-Iowa)," who helped write the SCHIP expansion legislation, "and now say that House Republicans' concerns about Medicaid should be resolved." Otherwise, Sen. Hatch said, "that will blow up the bill." However, Democrats argue that the SCHIP bill "isn't the place for debate on Medicaid, even though the two programs are related." House Democratic Caucus Chairman Rep. Rahm Emanuel (D-Ill.) stated, "If House Republicans are serious about providing healthcare to 10 million children, they should focus on SCHIP, not undermine Medicaid." Congressional Quarterly noted that SCHIP and Medicaid are indeed intertwined, a fact supported by 11 states which "simply treat SCHIP as a Medicaid expansion."
(Source: AMA Morning Rounds)
SCHIP vote postponed because lawmakers cannot agree on terms - Updated 11.14.07
In continuing coverage from previous briefings, Congressional Quarterly (11/14, Wayne) reports that lawmakers negotiating the State Children's Health Insurance Program (SCHIP) are not expected to reach a deal on a compromise before Thanksgiving. Ranking Senate Finance Committee member Charles Grassley (R-Iowa) said that "progress has been slow, in part because Democrats have had to walk a fine line in making concessions to Republicans, for fear of losing support from their own caucus." Referring to discussion about whether parents should be able to enroll, Grassley said, "There were some negotiations that went so far to satisfy some Republicans that it made it possible we'd lose some Democrats."
(Source: AMA Morning Rounds)
Senate passes revised SCHIP bill with veto-proof margin - Updated 11.6.07
For the second time this year, the U.S. Senate passed a bill expanding the State Children's Health Insurance Program (SCHIP). This move will likely to elicit criticism from the White House, which has repeatedly vowed to veto the bill if it were not revised to the President's satisfaction.
According to the Washington Times (11/2, Lengell), should President Bush veto this latest bill, it "will leave Capitol Hill lawmakers little time this year to work out a new long-term deal to expand the $5 billion annual budget for...SCHIP." However, SCHIP supporters appear determined to find a compromise which the President will accept.
(Source: AMA Morning Rounds)
House passes revised SCHIP bill without veto-proof majority - Updated 10.29.07
On Thursday, October 25, 2007, the House passed a revised bill against threats from President Bush of another veto. The revision will still provide health insurance for 10 million children. It passed with 265 votes, less than the two-thirds needed to override another presidential veto.
The October 26 article in New York Times noted that none of the Republicans who voted against SCHIP last week supported this revised version of the bill. Should this latest effort fail, "Democrats said [that] they might extend the existing...[SCHIP] program through next summer. They could then schedule a vote on the issue in September or October, in hopes of inflicting maximum political damage on Republicans just before the 2008 elections."
The Hill (10/26, Kaplan) adds, "Democratic leaders specifically focused on convincing 38 Republicans, who indicated in a letter sent last week to President Bush that they were open to compromise if certain changes were made to the bill Bush vetoed." But their efforts were unsuccessful. Rep. Ric Keller (R-Fla.) stated, "It's a bad bill. ... It's interesting that they wanted to sit down with us now. If they really wanted votes, they would have sat down with us before." The Hill notes that "[d]espite the rancor, Democrats lavished praise on Republicans, specifically GOP Sens. Orrin Hatch (Utah) and Chuck Grassley (Iowa), who had criticized the president's veto and carried the original SCHIP bill through the Senate in 1997."
The AP (10/26, Espo) reported, "Rep. Steny Hoyer (D-Md.), the majority leader, told reporters [that] additional changes are possible before...[the bill] heads to the White House." But he said, "'I don't want to be strung along' by Republicans merely feigning an interest in bipartisan compromise." The AP continues, "The children's health measure has emerged as one of the most contentious issues of the year, temporarily supplanting last winter and spring's fierce debate over the Iraq war." Recent polls "show widespread support for the issue, and the political subtext was never far from the surface in the debate."
Furthermore, the Baltimore Sun (10/26, Silva) quotes White House press secretary Dana Perino as saying, "Today, the House of Representatives passed another...SCHIP reauthorization bill that fails to cover poor children first. ... This bill does not address in a meaningful way the concerns the president raised, and so he will veto it if it reaches his desk." But SCHIP supporters argue that "[t]he legislation makes clear that: more low-income children are covered -- no 'high income' children are covered; benefits to illegal immigrants are prohibited; coverage of childless adults is phased out; and 'crowd out' is improved so fewer families will drop their private insurance."
The bill now goes before the Senate, which could vote on it as early as next week.
(Source: AMA Morning Rounds)
Presidential Veto Stands - Updated 10.19.07
The House upheld the SCHIP veto by falling 13 votes short of the two-thirds needed to override the president's earlier veto. The override effort failed even though there were multi-million dollar advertisements and displays by many children's advocacy groups in the capitol. Democrats have vowed to send it back to the president next month with some minor changes believing that it will make all the difference.
Rep. Adam H. Putnam (R-Fla.), chairman of the House Republican Conference, said, "Today, House Republicans voted to put poor kids first and pave the way for a responsible expansion of the SCHIP program." Only 44 Republicans voted to override, one fewer than had originally supported the bill. Two Democrats voted to uphold the veto, less than the six that voted against the bill originally.
"The new version will probably give Republicans some face-saving alterations but no substantive change, said House Speaker Nancy Pelosi (D-Calif.). But Pelosi emphasized that SCHIP must cover the 10 million uninsured children. "That's not negotiable," she said.
To see the final vote results, click here...
Democrats Attempt To Persuade Republicans To Override Veto - Updated 10.16.07
The House and Senate will vote Thursday to override the President's veto of the SCHIP expansion bill. Democrats are taking to the airwaves, staging a phone campaign and rallying in public arenas in the hopes of putting pressure on Republicans who might only side with the president because of party lines. The focus is mainly on a couple dozen Republicans that Democrats feel can be convinced into voting against the president and for the children. During his party's weekly radio address, Democratic Sen. Max Baucus stated, "Every Republican must decide whether they will stand with the president and his veto, or stand with our children and their right to a healthy future."
The vote is not expected to pass because a two-thirds majority vote in BOTH houses is required to override a presidential veto. While the Senate efforts proved worthwhile, the House vote fell about two dozen votes short of the requirement. Keep checking back for the results of the vote on Thursday...
AMA Alliance Members Call To Action - 10.15.07
Both the U.S. Senate and House have passed the bill which reauthorizes the Children's Health Insurance Program (CHIP)-but the president has vetoed this important legislation.
However, we can still pass this bill and ensure access to health care for nearly 10 million children in America!
Please click on the following link: https://mail.americanmedicalassociation.org/exchweb/bin/redir.asp?URL=http://capwiz.com/ama/issues/votes/?votenum=906%26chamber=H%26congress=1101
This link shows how each representative voted within a state (i.e., click on the state of Illinois and it shows Melissa Bean voted Yes, Judy Biggert voted No, etc.) You can then click on the representative's name who voted no and send them a personalized message asking her/him to override the president's veto.
OR
Congress can override a veto call using this grassroots hotline at (800) 833-6354.
Remind your Member of Congress:
- This bill will cover 10 million children.
- This bill is supported by the AMA, AARP, many governors and private insurers.
- Contrary to much misinformation, this bill focuses the program on serving low-income kids who are U.S. citizens. The legislation does not increase income eligibility limits, nor does it provide for coverage of illegal immigrants
- This bill is about ensuring that we do right by our children so that they can grow into healthy, productive adults
SCHIP Debate Continues – Updated 10.08.07
While Democrats and Republicans struggle with and plan ideas on how to support their party while providing health care to poor children across the country, President Bush is floating the idea of a compromise. The AP reported on October 7, "President Bush signaled Saturday that he may accept spending more on health insurance for children, but gave no specifics on how much higher he would go." During his weekly radio address, Bush said, "If putting poor children first takes a little more than the 20% increase I have proposed in my budget for SCHIP, I am willing to work with leaders in Congress to find the additional money." At the same time, he took the opportunity to reiterate his stance on what he term’s “the Democrat’s goal of government-run health care” by saying, "Government-run healthcare would deprive Americans of the choice and competition that comes from the private market. ... It would cause huge increases in government spending."
While this is the first attempt from the President at a compromise, he has not been clear as to how far he is willing to negotiate.
President Bush Vetoes SCHIP Expansion Bill – Updated 10.04.07
President Bush vetoed the long-debated bill sent to him for reauthorization of the State Children's Health Insurance Program (SCHIP) yesterday. He had threatened to veto any SCHIP proposal that called for an expansion of the already over-budget plan. The bill Congress sent for his approval “would have expanded health insurance for children by $35 billion. Democrats on the Hill and many Republicans support it. The President says it's too expensive," according to an October 3 lead story on ABC World News.
Congress was proposing an expansion of the SCHIP bill, which currently provides health insurance to six million poor children, to cover around ten million children. According to CBS Evening News on October 3, “the President says that would include more than the poor." President Bush denies that the reason for his veto is that he doesn’t care about poor children, and states that the new SCHIP bill should continue to cover the poor without expansion that would allow coverage of children from higher income brackets, which he has argued is an attempt to transition to a government-run health care system.
According to the October 4 New York Times, the president stated, "I do want Republicans and Democrats to come together to support a bill that focuses on the poor children. ... And if they need a little more money to help us meet the objective of getting help for poorer children, I'm more than willing to sit down with the leaders and find a way to do so." However, agreement on a budget amount could be the factor that drags this issue on for many months. The President has mentioned a $5 billion increase to SCHIP over a five-year period, which is much less than the $35 billion proposed by Congress. Most SCHIP supporters on Capitol Hill are focused on overturning the veto before any compromise on budgeting will be considered.
SCHIP Background
SCHIP: Showdown Over Children's Health
By Rosetta Gervasi
Agreeing to provide basic health care for poor children seems like it would be a slam dunk-a noncontroversial no-brainer that anyone would have to be either a fool or an ogre to oppose. It would be like calling for the massacre of puppies and kittens. Like hunting Bambi and Bugs Bunny.
Plus, just about anyone should be able to see it for what it is in the real world-political suicide. Look at the statistics: The popular State Children's Health Insurance Program (SCHIP) has been in place for 10 years and has earned a reputation for efficiency and success. In some states, a single visit to a hospital emergency room, typically the health care of last resort for the uninsured, can cost society almost as much as covering kids for a full year through the program.
SCHIP was established in 1997 by Congress as a means to cover children in families that earn too much to qualify for Medicaid, but too little to buy private insurance. The program is funded jointly by states and the federal government, with about 70 percent picked up by the latter. The program will end September 30 unless it is reauthorized by Congress.
In the past decade, the program has provided care for millions of children and reduced the number of uninsured significantly.
Which is good news all around because as reported by the St. Louis Post-Dispatch on August 23, children who have regular access to care stay healthier, miss fewer days of school and are more likely to get regular exercise.
Currently, about 6.6 million children are covered through SCHIP, and of the estimated nine million still without health insurance, between five and six million are eligible for the program.
And Americans-voting Americans-support it by a healthy margin. According to a recent University of Michigan report, nearly two out of three adults support it for children in families with incomes as high as $48,500, or 300 percent of the federal poverty level (FPL). In addition, a Wall Street Journal Online/Harris Interactive poll conducted August 16-20, 2007, found that 58 percent of U.S. adults, including half of all Republicans, agree that expanding the program is a good idea. And another poll released August 24, found that nine of 10 registered voters (86 percent) said they would support reauthorizing SCHIP, and 63 percent said they would extend SCHIP's budget by an additional $35 billion.
What's the Problem?
So, what is the problem? Just who is opposing this effective, successful program and why? The New York Times article published July 8 crystallized the debate: The seemingly uncontroversial goal of insuring more children has become the focus of an ideological battle between the White House and Congress. The fight epitomizes fundamental disagreement over the future of the nation's health care system and role of government." And the Congressional Record writing on July 23, predicted that the confrontation between SCHIP proponents and opponents "could evolve into one of the big domestic policy debates of the Bush era."
There you have it. Proponents see it as a simple matter of providing care to the millions of children who are still without it. Opponents, including the White House, see it as a back-door maneuver toward a government-sponsored, single-payer health care system. In fact, the August 23 St. Louis Post-Dispatch article quotes the President commenting about SCHIP: "I wouldn't call it a plot, just a strategy to get more people to be part of a federalization of health care."
According to a Los Angeles Times article from June 28, Bush also said that Democrats want to "take incremental steps down a path toward government-run healthcare for every American-a wrong path for our nation." He added that it would "eliminate choice and competition in healthcare, cause huge increases in government spending that could lead to higher taxes, and result in rationing, inefficiency and long waiting lines."
Notwithstanding the President's comments, Newsday reported on August 23, that most children covered by SCHIP, the program pays for care delivered by private plans. Nevertheless, to give Bush his due, the program has already grown beyond the scope of Congress' original intent in establishing it in 1997. Robert Novak writing in the Chicago Sun-Times on June 28, noted that originally the program was passed at an outlay of $4 billion dollars per year, and that the program's "faults" have largely been overlooked. "The federal government consistently granted waivers to permit 14 states to cover adults under SCHIP, which now costs $5 billion a year," wrote Novak. He also noted that in Minnesota, 92 percent of money spent under the program goes to adults.
How Did We Get Here?
Just how did a program clearly earmarked to provide basic health coverage for the nation's needy children come to become the centerpiece of a contentious legislative and policy debate? A decade ago, when Congress established the program, the legislative body gave states some discretion in deciding which populations to cover, and over the years, several sates have expanded the program to cover children in middle-income families as well as some adults.
The Bush administration complains that many states have distorted the original intent of the program by raising the eligibility limit to as high as 350 percent of the FPL. That's true. States began expanding the SCHIP's income requirements to include more children from families with higher incomes. Currently, 19 states and the District of Columbia provide health insurance to children in families with incomes more than 250 percent of FPL or are in the process of doing so. Missouri covers children in families earning up to three times the FPL, and Illinois covers all children with a combination of programs, Including SCHIP. However, in both Missouri and Illinois, children in families earning more than twice the FPL have to pay premiums to enroll children. At least 10 states have adopted or are considering proposals from families that earn up to three times the FPL, and some states like New Jersey and New York are seeking federal approval to go to 400 percent (that's a household income of $82,600 for a family of four.)
Bush and Republican legislators warn that the coverage expansion not only goes beyond the original intent of Congress, but might serve as an incentive for families with private coverage to drop it and enroll their children in SCHIP due to the lower costs. In fact, one study reported in the New York Times on August 22, found that 14 percent of enrollees did just that.
Another bone of contention in the debate over the future of SCHIP is that more controversial legislation is being tacked onto the reauthorization and expansion bills. For instance, the bill approved by the House of Representatives just before their August break would also prevent Medicare physician cuts for the next two years, according to American Medical News. The Children's Health and Medicare Protection Act of 2007 (CHAMP), passed by the House on August 1, would turn the 9.9 percent and 5 percent Medicare payment reductions expected in 2008 and 2009 into 0.5 percent increase for each year. The bill also includes provisions of $50 billion over 10 years to help Medicare beneficiaries in the form of payments to Medicare Advantage plans, and extends a number of rural health provisions, which are set to expire.
Administrative Maneuverings
While Congress debates the future of the children's program with nary a glance at the President's agenda, the administration is fighting back. Newsday reported in late August that first President Bush pushed a funding increase so small that [according to the Congressional Budget Office] it would have made it impossible to continue covering all existing beneficiaries. That proposal was ignored by Congress, so in August, the administration announced rules that would impose additional costs on beneficiaries and establish hurdles for states that want to expand the pool of eligible children that qualify for the program.
The new rules, outlined in a letter from Dennis G. Smith, director of the federal Centers for Medicaid and State Operations, to state health officials on August 17, make it nearly impossible to comply, say state officials. They are taking issue with the letter not only for its content, but also for its timing. According an August 21 New York Times piece, the letter was sent during a month-long Congressional recess, and on a Friday, a traditional dead zone for media coverage.
Under the new requirements, children must be without insurance for a year before they can be enrolled, and families of children in the program must pay fees comparable to those paid by families with private insurance. In addition, states must show that they have enrolled at least 95 percent of children below 200 percent of FPL and that the number of children insured through private companies has not dropped more than two percentage points over five years. The letter spells out a list of restrictions that would stop any SCHIP expansions and force states to change their rules to comply with the federal order. The 95 percent threshold is considered especially onerous as no state has yet met it or is likely to do so anytime soon. The letter also stated that the steps outlined must be implemented within a year.
In interviews following the issue of the new rules, administration officials said the changes were intended to return SCHIP to its original focus on low-income children and to make sure the program did not become a substitute for private health insurance, according to the August New York Times article.
At least 18 states would be forced to scale back or abandon planned expansion of their SCHIP plans as a result of the new rules, according to a New York Times article published August 22. States are preparing written responses calling for revisions to the new rules, and failing that, will work to alter or sidestep the rules by passing legislation, according to the report. In addition, senators from both sides of the aisle are threatening to block the new regulation, according to the August 24 issue of Congressional Quarterly.
The San Francisco Chronicle article on August 23, speculates that the reason for the administration's rules is that Congress could probably override a presidential veto of the SCHIP reauthorization. The President has said repeatedly that he will veto any reauthorization bill that attempts to expand the program beyond its original intent.
What Happens Now?
As the administration proceeds to define the future of SCHIP by rule, Congress is proceeding with a legislative solution. Following on the heels of the House passage of CHAMP, the Senate passed its own reauthorization and expansion bill, the Children's Health Insurance Program Reauthorization Act of 2007, with 18 Republican senators voting for it in defiance of the President's threats to veto. The Senate bill doesn't provide for a physician pay fix but passed by a wide margin-substantially more than enough to override a veto.
Both the House and Senate versions of the reauthorization legislation continue SCHIP for five years, the House with a price tag of $50 billion and the Senate calling on $35 billion for the program, both allowing enrollment of children from higher-income families. The House bill would provide enough funding to almost double the number of children covered to about 11 million, while the Senate version could add about three million children. Both the House and Senate bill rely on steep increases to federal taxes on tobacco products to fund the expansion-61 cents in the Senate version and 45 cents in the House bill.
When Congress reconvenes in September, a House-Senate conference committee will try to reconcile the differences to produce a compromise bill to send to the President for signature.
In the meantime, since SCHIP is due to expire at the end of September, plans are also in the works to deal with the program on an interim basis.
A law signed on May 25 will provide $650 million in federal funds to fill budget shortfalls in SCHIP this year. The money will we divided among 14 states that expected to run out of SCHIP money before September 30, the end of the fiscal year.
Those hefty increases in the federal tobacco taxes, which might prove contentious details for a Congressional conference committee to work out due to concerns from legislators that are from tobacco-growing states, are precisely what makes the proposed legislation so attractive to the American Medical Association (AMA) and the AMA Alliance.
Where We Stand
On August 17, the Alliance issued a statement commending Congress for passing legislation "to ensure the future health of our children." In part, the statement, attributable to Alliance President Dianne C. Fenyk, noted that, "As spouses of physicians, our number one priority is family-protecting the health and welfare of the most vulnerable in our society...Moreover, we are pleased that the proposed legislation would serve as a deterrent to smoking and is aligned with our nationwide anti-smoking Screen Out! program...a step in the right direction toward a smoke-free America."
And Sandi Frost, the Alliance's president-elect explains what makes using tobacco taxes to provide health care to children ideal: "It seems a natural to me-reduce the devastating effect of tobacco on our children while at the same time using the revenue from those harmful products to do some good-protecting our children's future.
"I saw an article recently that said higher cigarette prices and consequently lower legal cigarette purchases accounted for a 19 percent decline in smoking in New York City. Think of the positive outcomes if those numbers were multiplied across the country."
Senator Gordon Smith (R-Ore.) who originally proposed the 61-cent increase would seem to agree. He told USA Today on July 11 that, " It really does seem to come down to a choice between children and tobacco. This is a two-fer. It does decrease smoking and it does connect public health care costs with one of the drivers of that cost..."
That position is backed by the research. Data from the American Cancer Society Action Network show that for every 10 percent increase in the price of cigarettes, there is a corresponding seven percent drop in youth smoking rates and a four percent decline in adult smoking.
AMA agrees that using tobacco taxes to fund SCHIP is a "win-win" proposal. In a statement issued on August 3 and attributable to association President Rob Davis, M.D., AMA said of the tobacco tax proposals: "Kids in low-income families get the health care they need, and it's paid for with an increase in federal tobacco taxes that can help deter current and future Americans from using tobacco."
As a member of the Health Care Coverage Coalition for the Uninsured, the AMA supports full SCHIP funding to cover all eligible children and advocates using the tobacco tax increases proposed to cover the expansion, according to AMNews. At AMA's annual meeting in June, delegates approved an AMA policy calling for reauthorization of SCHIP before it expires at the end of September, and also called for a commitment from Congress of more than $60 billion over five years to fund it.
Indeed, AMA's endorsement of the program's expansion is offered by some as an assurance that the program is not a start down a slippery slope of a government-sponsored health care delivery system. Rep. Lloyd Dogget (D-Texas) commented in the New York Times on August 2 that, "The Republicans silly claims of socialized medicine are belied by the [House SCHIP reauthorization] bill's endorsement by the American Medical Association."
Next Steps
Reauthorization and even some level of expansion for SCHIP is not a matter of real debate. It's considered a forgone conclusion. What does remain to be seen, however, is the scope of the expansion and what will happen if Bush follows through on his threats to veto any bill that expands the program beyond the fiscally conservative limits he has outlined.
How the SCHIP reauthorization issue, rather than if, it is resolved could be a harbinger of how the long-awaited Congressional debate over the future of American health care will ultimately play out.