Government

House panel advances SCHIP reauthorization bill

Republicans slightly delay $75 billion legislation while releasing their own $36.5 billion version.

By Doug Trapp — Posted Aug. 13, 2007

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

The House debate on reauthorizing the State Children's Health Insurance Program turned partisan as Republicans cried foul over their limited opportunity to review the legislation before two committee votes.

But their delaying tactics were unable to keep the bill from moving out of one committee. The measure would add $50 billion to SCHIP over five years, bringing total program funding to $75 billion for that period.

It also would provide 0.5% payment increases for physicians in Medicare in both 2008 and 2009, instead of the 9.9% and 5% reductions predicted under current law.

President Bush threatened to veto the bill, and House Republicans entered the debate by offering SCHIP legislation. Their measure would add about $11.5 billion to the program, for a funding total of $36.5 billion over five years.

The Energy and Commerce Committee and Ways and Means Committee were scheduled to vote on the Children's Health and Medicare Protection Act of 2007, as the Democrats' bill is formally known, on July 26. But only the Ways and Means panel approved the measure, in a 24-17, party-line vote.

Energy and Commerce Chair John Dingell (D, Mich.) adjourned his committee without a vote late on July 27 because the bill faced further stalling by GOP lawmakers.

Republicans in both committees, upset that they had about 36 hours to review the 465-page bill, used parliamentary tactics to require that the entire bill be read aloud before a vote could be taken. In Energy and Commerce, that required about 18 hours when combined with delays for House votes and numerous interjections and verbal volleying from members of both parties.

House leaders expected to move a single version of the bill to the House floor via the Rules Committee, said a spokeswoman for Energy and Commerce Democrats. That would help set the stage for full House and Senate votes on their respective SCHIP bills before their month-long August recess.

But work on the House bill's financing wasn't finished. The Congressional Budget Office estimates that the measure would create a $72.9 billion deficit over 10 years, entirely in the latter five years. Democrats have pledged to find offsets for all new spending and to resolve this issue before the bill reaches the House floor.

6 million more

The House measure intends to cover an additional 6 million people, mostly children, including 4.1 million who are now uninsured. The program currently covers about 6 million children and about 600,000 adults.

The bill would allow states to continue to set their own SCHIP income limits, add both mental health parity and dental care to the program, and improve access by offering bonus payments to states offering presumptive eligibility, continuous eligibility and auto-renewals.

The measure also would gradually increase the eligibility age to 24 by 2013.

The bill would pay for the changes by boosting federal cigarette taxes by 45 cents, to reach 84 cents a pack, which would raise $27 billion over five years. It also would reduce subsidies to Medicare Advantage plans by $50.4 billion over five years, according to the CBO.

On July 19, the Senate Finance Committee approved an SCHIP reauthorization bill, which would provide $35 billion in additional five-year funding through a 61-cent federal cigarette tax increase. It would cover an additional 4.8 million people by 2012, nearly all children, including 3.2 million uninsured, the CBO estimated. But the legislation does not address Medicare physician payment cuts.

If both bills are approved by their respective chambers before the recess, a conference committee would likely be held in August to craft a final bill for approval in September. SCHIP expires Sept. 30.

The American Medical Association has written letters of support for both the House Democrats' and Senate Finance panel's SCHIP reauthorization bills. But the AMA would support additional spending. At their June Annual Meeting, Association delegates passed a resolution calling for $60 billion in additional funding over five years.

Republicans: Scale back SCHIP

As the Democrats' SCHIP bills advanced, House Republicans joined the debate by offering a measure limiting the program to more moderate-income enrollees. Senate Republicans pledged to introduce their own focused SCHIP bill.

The $36.5 billion SCHIP Reauthorization and Reform Act of 2007, sponsored by Rep. Joe Barton (R, Texas), ranking member of the Energy and Commerce Committee, would restrict most enhanced federal matching funds for SCHIP to families at or below 200% of the federal poverty level. States with 90% of enrollees at or below that mark could extend coverage to those earning 250% of the poverty level. The measure has at least 12 Republican co-sponsors.

Barton said requiring electronic prescriptions could help pay for his proposal by saving up to $3 billion over five years, but that provision was not in the bill.

The text of the Senate Republicans' bill was not available at press time. But a spokeswoman for Sen. Mitch McConnell (R, Ky.) said that in addition to providing SCHIP funding, the measure would allow small businesses to pool together to buy health insurance and would allow employers to contribute more to the health savings accounts of chronically ill employees.

Republicans on the House Energy and Commerce Committee said the Democrats' SCHIP measure would reduce choice, in part, by reducing funding to Medicare Advantage health plans.

Rep. John Shadegg (R, Ariz.), summing up the concerns of many of his Republican colleagues, said the SCHIP debate is the opening salvo in the battle over the future of health care in America.

"The question is are we going to move toward government-run, bureaucratic-controlled, rationed health care or are we going to move to increase patient-centered health care, giving individual people control over their health care decisions?"

Democrats responded by noting that SCHIP is government-funded but administered by private insurance companies selected by the states.

Bush said he would veto the $75 billion House SCHIP bill, according to a letter from Dept. of Health and Human Services Secretary Mike Leavitt to House committee leaders.

Bush already had promised to veto the $60 billion Senate bill. He proposed adding $5 billion, for total five-year SCHIP funding of $30 billion.

Back to top


ADDITIONAL INFORMATION

Varied visions

There are three State Children's Health Insurance Program reauthorization bills under consideration, possibly with more to come.

Senate Finance Committee: Children's Health Reauthorization Act of 2007

Five-year cost: $60 billion
Cigarette tax increase: 61 cents
Covers: Children and pregnant women in families earning up to 300% of the federal poverty level. It would cover an additional 3.2 million uninsured people, mostly children.

House Democrats: Children's Health and Medicare Protection Act

Five-year cost: $75 billion
Cigarette tax increase: 45 cents
Covers: Does not place new income restrictions for SCHIP or Medicaid eligibility on states. It would cover an additional 4.1 million uninsured people, nearly all children.

House Republicans: SCHIP Reauthorization and Reform Act of 2007

Five-year cost: $36.5 billion
Cigarette tax increase: None
Covers: Children and pregnant women in families earning up to 200% of the poverty level, with some exceptions allowing enrollees up to 250% of poverty. The number of additional children covered was not yet available.

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn