Congressional leaders on Tuesday said that they will attempt to override new standards for SCHIP enrollment that aim to limit coverage to the lowest-income children -- the "latest volley in the national battle over the future" of the program, the Boston Globe reports (Dembner, Boston Globe, 8/22). Under the new standards, states must demonstrate that they have "enrolled at least 95% of children in the state below 200% of the federal poverty level" who are eligible for Medicaid or SCHIP before expanding eligibility to children in families with incomes greater than 250% of the poverty level, according to a letter sent Friday to state officials by Dennis Smith, director of the Center for Medicaid and State Operations.

States seeking to expand SCHIP eligibility also "must establish a minimum of a one-year period of uninsurance for individuals" in families with incomes greater than 250% of the poverty level to prevent them from switching from a private insurance plan to a public program, the letter states. Smith wrote that states should impose copayments and premiums that are similar to the cost of private health insurance on middle-income families to prevent them from dropping private coverage to enroll in SCHIP.

States that insure children in families with annual incomes greater than 250% of the poverty level also must prove that "the number of children in the target population insured through private employers has not decreased by more than two percentage points over the prior five-year period," according to the letter. In addition, states will need to adopt policies "preventing employers from changing dependent-coverage policies that would favor a shift to public coverage," Smith wrote (Kaiser Daily Health Policy Report, 8/21).

Reaction
Washington state Sen. Chris Marr (D) said that new standards are an example of "legislating by agency edict," a process that is not "answerable to the public or to the legislators." Sen. Maria Cantwell (D-Wash.) in a statement said, "The president knows that Congress has enough votes from both parties to overcome the veto he threatened over" the SCHIP bills, "so now he's trying something else," adding, "I hope he will stop and put aside political grandstanding so that more than 10 million American children can have a healthier future" (Aleccia, Spokane Spokesman-Review, 8/22).

Rep. Pete Stark (D-Calif.) said that none of the states "are going to get 95% of people signed into these programs," adding that administration officials "have set a hurdle that's impossible. They might as well just come out and say, 'let's kick kids off the rolls'" (McClatchy/Hartford Courant, 8/22). He continued, "I can't try and guess what kind of mindset would foster this." Stark added that the proposal "cuts down the ability of the states to provide medical care to children" (Bloomberg/Winston-Salem Journal, 8/22).

White House Response
Smith said the new guidelines are "aggressive, but doable" (McClatchy/Hartford Courant, 8/22). According to Smith, "SCHIP was created for children in low-income families. We want to make sure those kids are covered before we go to the higher-income kids" (Boston Globe, 8/22).

White House spokesperson Tony Fratto on Tuesday said that the new guidelines would prevent SCHIP from becoming "essentially a middle-class entitlement," adding, "As states have expanded into higher income levels, we actually are seeing SCHIP become a substitute for private insurance." Fratto said, "States are looking to vastly expand eligibility for SCHIP at a time when no states are making adequate progress in enrolling the target populations, which are families with children at, or below, 200% of the poverty line" (Bloomberg/Winston-Salem Journal, 8/22).

New York Efforts
New York Gov. Eliot Spitzer (D) said he will lobby against the new rules, which endanger his plans to expand eligibility in the state to children in families with annual incomes less than 400% of the poverty level. Expanding eligibility to that level would effectively cover all children in the state and would give New York the highest SCHIP income ceiling in the nation.

State health officials, including Deborah Bachrach, state deputy commissioner of the Office of Health Insurance Programs, are preparing a written response to federal officials that will argue for changes to the guidelines. If the response is not effective, the Spitzer administration will work with national lawmakers from New York and other states to pass a law altering the guidelines.

If Spitzer moves forward with the SCHIP expansion without federal approval, the state will have to contribute an additional $41 million in lost federal funding. The state enrolls about 88% of children eligible in families with annual incomes less than 200% of the poverty level, falling short of the new guidelines, and leaving about 60,000 children ineligible for SCHIP under the new rules (Confessore, New York Times, 8/22).

Other Comments
Sen. Edward Kennedy (D-Mass.) in a statement said, "Once again, the Bush administration has shown itself to be out of touch and out of step with the priorities of working Americans," adding, "The administration's action denies the promise of good health to thousands of children in communities across America" (Boston Globe, 8/22). Pennsylvania Gov. Ed Rendell (D) in a statement said, "If the president is serious about market solutions to our health care crisis, he should be expanding, not cutting back, the public-private partnership that has made health insurance affordable for thousands of Pennsylvania children," adding, "We should not be making it harder for children to get the health care they need" (Fahy, Pittsburgh Post-Gazette, 8/22).

Pamela Farley Short, professor and director of the Center for Health Care and Policy Research at Pennsylvania State University, said that SCHIP "isn't just about money" but "is about investing in children's health and future" (Boulton/Forster, Milwaukee Journal Sentinel, 8/21).

Eligible Uninsured Children
In related news, the Times on Tuesday examined how efforts to find and enroll uninsured children that are eligible for SCHIP is a "fundamental debate" that "has been raging in Washington for months" as lawmakers work on legislation to reauthorize and expand the program.

States have increased efforts to enroll children through outreach; eliminating waiting periods; simplifying the application process and income verification methods; and providing translators to immigrants.

However, the challenges of finding eligible children "demonstrates how difficult it will be for states to meet the new standards" announced by the Bush administration on Friday, according to the Times. "We've beat the bushes every which way but loose to find these kids," but "we know there are still a lot of them out there," Janice Cardin -- the supervisor in Guilford County, N.C., for Health Choice, the state's version of SCHIP -- said (Sack, New York Times, 8/22).

Opinion Piece
House SCHIP reauthorization legislation (HR 3162), is a "critically misguided" effort that "severely cuts medical benefits for seniors," Rep. Tim Murphy (R-Pa.) writes in a Pittsburgh Post-Gazette opinion piece. According to Murphy, the bill "creates loopholes allowing people to qualify for coverage for which the SCHIP program was never intended," including individuals up to age 21 "who are certainly no longer children." In addition, the House version could allow undocumented immigrants and families with annual incomes greater than $100,000 to qualify for the program, Murphy writes. "It is not fair to cut benefits for fixed-income seniors so that people who can afford health care can receive a government subsidy," Murphy says.

He concludes, "Congress must focus on real health care reform," adding, "Reducing medication errors, eliminating infections and other patient safety measures would save hundreds of billions of dollars each year, enough to fund SCHIP without having seniors lose their benefits" (Murphy, Pittsburgh Post-Gazette, 8/22).

Broadcast Coverage
American Public Media's "Marketplace" on Tuesday included a discussion with "Marketplace" Washington, D.C., bureau chief John Dimsdale on the debate over SCHIP (Ryssdal, "Marketplace," American Public Media, 8/21). Audio and a transcript of the segment are available online.

NPR's "Morning Edition" on Wednesday also reported on SCHIP. The segment includes comments from Ann Kohler, New Jersey deputy commissioner of human services; Smith; and Judith Solomon, a senior fellow at the Center on Budget and Policy Priorities (Rovner, "Morning Edition," NPR, 8/22). Audio and a partial transcript of the segment are available online.