SCHIP Bill Passes House: First Step in Expanding Health Insurance for Kids

The bill advances Obama's pledge to get all Americans health coverage.

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The bill reauthorizing the State Children's Health Insurance Program that the House of Representatives passed yesterday will extend health coverage to an additional 4 million lower-income kids over the next 4 1/2 years, bringing the total to 11 million. The Senate expects to take up a similar measure today, paving the way for Barack Obama to sign the bill soon after taking office.

The present bill is an important first step in making good on Obama's campaign pledge to cover all Americans. It allows states to waive the five-year waiting period for children of legal immigrants that has prevented an estimated half million from getting coverage. And the bill provides for $100 million in grants to encourage states to streamline and simplify outreach and enrollment. This is critical. Yearlong waiting periods and onerous documentation requirements have discouraged eligible kids from obtaining coverage in some states. "We need to get rid of barriers to getting enrolled and staying enrolled," says Susan Gates, general counsel for the Children's Defense Fund.

But there are still going to be roughly 5 million kids without health insurance once SCHIP passes, primarily those from families that make too much money to qualify for subsidized coverage. In many states, "too much" means anything over 200 percent of the federal poverty level, or roughly $40,000 for a family of four. Thirty percent of uninsured children come from such families, according to the Kaiser Family Foundation.

In a statement following the vote, Obama said, "In this moment of crisis, ensuring that every child in America has access to affordable healthcare is not just good economic policy but a moral obligation we hold as parents and citizens." True enough, but it's not clear how the remaining 5 million uninsured kids will get access to affordable healthcare. There's this: As the faltering economy causes more people to lose their jobs and their health insurance, their incomes may plummet to levels where they have the dubious good fortune of qualifying for SCHIP or other programs. And proposals that would make it easier for laid-off workers to hang on to their former employer's health benefits under federal COBRA law would help, too. Word is that the stimulus plan may include this. But the safety net isn't going to catch everyone who needs help. In the end, achieving universal coverage for all kids will probably still require a mandate that children have insurance, many experts agree. Obama has said he supports this. But we'll leave that politically combustible topic for another day.