State Children's Health Insurance Program Reauthorization: Will It Get Us Closer to Universal Coverage for America's Children?

The State Children's Health Insurance Program (SCHIP) was passed by Congress in the Balanced Budget Act of 1997 during the Clinton presidency. The legislation appropriated approximately $40 billion for 10 years, 1998–2007.1 By 2003, 4.4 million children were enrolled in separate SCHIPs, and an additional 1.6 million were enrolled in SCHIP-financed Medicaid expansions.1 As of 2006, 7 states (Vermont, New Jersey, Connecticut, Maryland, New Hampshire, West Virginia, and Massachusetts) had expanded their SCHIP eligibility to families who are earning at least 300% of the federal poverty level (FPL), which will make almost all uninsured children who are US citizens eligible for public programs. The governors of California, Pennsylvania, Oregon, and Wisconsin have also introduced initiatives that include SCHIP expansions to substantially reduce the number of uninsured children in their states. In 2007, SCHIP must be reauthorized by Congress with a new appropriation of funds to continue to function in 2008. Because SCHIP is a block grant or capped-grant program, a number of states that established programs having higher income-eligibility thresholds, better outreach and marketing, and more streamlined enrollment procedures are projected to have a shortfall in federal support in 2007. For fiscal years 1998 through 2001, the annual appropriation was slightly over $4.2 billion. The appropriation dropped to under $3.2 billion from 2002 through 2004 but then increased to $4.1 billion for 2005 and 2006 and $5.0 billion in 2007.2 Because of greater than anticipated enrollment and per capita expenditures, the states’ total spending of federal SCHIP funds has exceeded the annual appropriations since 2002. The shortfalls of federal SCHIP funds after 2002 were covered by redistributing … Address correspondence to Stephen Berman, MD, FAAP, Children's Hospital, 1056 E 19th Ave, B032, Denver, CO 80218. E-mail: berman.stephen{at}tchden.org