A dispute over upper-income limits on Medicaid eligibility has become the "primary obstacle" to completing negotiations on revised legislation that would reauthorize and expand SCHIP, according to lawmakers, CQ Today reports. House Republicans, who initially discussed the issue last week, want the SCHIP bill (HR 3963) to limit eligibility for Medicaid to 300% of the federal poverty level in an effort to prohibit states from using the program to expand government-sponsored health care coverage to middle-income families. Democrats say that the SCHIP bill is not the proper vehicle for debating Medicaid policy change, according to CQ Today.

Although no states have expanded Medicaid eligibility above 300% of the poverty level, Democrats say they do not want to make it impossible to do so. A Senate Democratic aide said, "We would never agree to cap Medicaid," adding, "That has never been on the table."

However, House Republicans "appear to have won two important allies" in Sens. Orrin Hatch (R-Utah) and Chuck Grassley (R-Iowa), both of whom helped write the legislation and "now say that House Republicans' concerns about Medicaid should be resolved," according to CQ Today. Hatch said, "If not, that will blow up the bill."

Grassley noted that Democrats have said they do not want Medicaid to expand above 300% of the poverty level but "they're not willing to put language into the bill that the House Republicans want that would guarantee that." He added, "It seems to me we all agree on the policy; why can't we write it?" The dispute over an upper eligibility cap for Medicaid has "inflamed both sides," according to CQ Today.

Although Senate Finance Committee Chair Max Baucus (D-Mont.) has said that talks will continue after the Thanksgiving recess, a Senate Republican aide said that lawmakers are preparing to focus on Medicare upon their return. "I think SCHIP might be left to simmer on the back burner for a while," the aide said. SCHIP funding will continue at current levels through a continuing resolution that expires Dec. 14 (Wayne, CQ Today, 11/16).

In related news, House Speaker Nancy Pelosi (D-Calif.) at a rally on Saturday in Texas called for the expansion of SCHIP, the AP/Fort Worth Star-Telegram reports. Pelosi said, "If we can afford a war, we can afford to insure our children," adding, "We will not rest until 10 million children are covered" (AP/Fort Worth Star-Telegram, 11/17).

School Districts Help Uninsured
McClatchy/Miami Herald on Sunday reported that while Congress and President Bush "squabble" over the reauthorization of SCHIP, school officials nationwide "are scrambling each day to find affordable medical care so that sick and needy students can continue to learn." According to McClatchy/Herald, growing numbers of uninsured students have "made it harder for educators to focus on classroom achievement without first addressing the medical needs of their students who lack health insurance or dental coverage."

School officials "increasingly must help find health care, arrange transportation for sick children and often advise beleaguered parents about the health consequences of their inaction," McClatchy/Herald reports. Chandrai Jackson-Saunders, a school psychologist in Washington, D.C., said that the lawmakers' inability to reauthorize SCHIP "looks like education neglect on the part of the government," adding, "It's a very disheartening situation" (Pugh, McClatchy/Miami Herald, 11/18).