SCHIP's Fate Unclear as Congress, President Clash

With the end of the year drawing near—and Congress past due to adjourn—the fate of the reauthorization of the State Children's Health Insurance Plan was unclear.

SCHIP received one reprieve in October when Congress approved a continuing resolution to keep the government operating through at least mid-November. The resolution kept funding at current levels for all government programs. As that November deadline approached at press time, the House had come up with another continuing resolution, which it attached to next year's defense spending bill, but the Senate had not taken up the legislation.

The continuing resolutions at least kept SCHIP operating. But without funding increases—as were promised under a reauthorization—many states were slated to start cutting enrollment as early as January.

About 6 million children are currently enrolled in SCHIP. The congressional proposal under consideration would increase funding by about $7 billion a year, adding as many as 4 million children to the SCHIP rolls.

What had seemed like a foregone conclusion early this year—that no one would question SCHIP's success and it would be easily refunded for 5 more years—was a distant memory by the time House and Senate negotiators sat down last month to discuss how to avert a second White House veto.

President Bush's first veto came in October. Soon thereafter, the House voted 273-156 to override the veto; that tally was 10 votes short of the needed two-thirds majority. The vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of override, and 154 Republicans and 2 Democrats voting against.

With that failure, the House took up a new SCHIP package on Oct. 25, voting 265-142 in favor. However, there were no new Republican converts, making it doubtful that the bill would survive another presidential veto. The Senate approved the same package by a vote of 64-30.

House and Senate leaders delayed sending the bill to the president, hoping to work out a compromise in conference that would withstand White House scrutiny.

Negotiators from the Bush administration were intent on making sure that at least 500,000 children who are currently eligible for SCHIP but not receiving benefits would be enrolled, according to a White House statement. "If enrolling these children requires more than the 20% funding increase proposed by the President, we will work with Congress to find the necessary money," the statement noted.

House Republicans said they also would work to ensure that only low-income children would receive SCHIP benefits, and that the program would not extend benefits to illegal immigrants.

At press time, negotiators were deep in discussions over how to ensure that those requirements might be met, said Ron Pollack, executive director of the advocacy group Families USA, in an interview.

The goal of covering 10 million children and financing the program through an increase in the tobacco tax was not at issue among congressional negotiators, said Mr. Pollack. The Bush administration, however, has said it is adamantly opposed to a tobacco tax increase.

Children's advocates and physician organizations continue to be perplexed by the White House stance. After the initial veto, Dr. Jay E. Berkelhamer, president of the American Academy of Pediatrics, said in a written statement that "the rhetoric of those who opposed the legislation to reauthorize SCHIP demonstrated a fundamental misunderstanding of the bill."

He noted that the first package passed by Congress would have blocked the enrollment of many adults and children that the White House considered not eligible, "while still providing states flexibility and financial support for enrollment of up to 4 million low-income eligible children."