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Clinton, Dingell Collaborate in Effort to Expand SCHIP Coverage

By Alex Wayne, CQ Staff

March 14, 2007 -- Presidential contender Hillary Rodham Clinton joined with House Energy and Commerce Chairman John D. Dingell on Wednesday to propose a huge expansion of public health insurance for children.

The New York senator and Michigan lawmaker, both Democrats, said they planned to introduce legislation Wednesday or Thursday intended to extend health insurance to all 9 million U.S. children estimated to be without it.

"It is a disgrace that in the wealthiest country in the world, nearly 9 million children lack health coverage," Dingell said.

The draft companion bills would boost spending on the State Children's Health Insurance Program (SCHIP) to encourage states to cover all children from families with incomes up to 400 percent of the federal poverty level, and would allow families ineligible for SCHIP to buy into the program. In states that expand eligibility to the level allowed in the bill, employers would get subsidies so they would not drop children from private insurance plans.

SCHIP, created in 1997, is a joint state–federal effort, similar to the much larger Medicaid program. It covers about 6 million children, as well as about 600,000 adults, at a cost averaging $4 billion over the past 10 years.

The program will expire Sept. 30 without congressional action. Most Democrats and many Republicans say they not only want to renew the program, but to greatly expand it.

Dingell will write the House's SCHIP reauthorization; his and Clinton's legislation likely represent the upper limit of any expansion. Congressional Republicans will probably insist on a scaled-back expansion in any final legislation.

President Bush has proposed spending about $30 billion on SCHIP over the next five years—some $45 billion less than proposals floated by congressional Democrats. Bush would reduce eligibility for children and discourage states from using the program to insure adults.

Earlier this week, Senate Budget Chairman Kent Conrad, D-N.D., said his proposed fiscal 2008 budget resolution would allow up to $50 billion in increases to SCHIP over five years, which he said would be enough to cover every child who currently does not have health insurance. Conrad said $15 billion in offsets would be identified in the budget, and an additional $35 billion was contingent on finding further offsets.

Broad Support for Expansion

Health insurance likely will be a major issue in the 2008 presidential race, with nearly 47 million Americans lacking coverage in 2005, according to the U.S. Census Bureau. Two leading contenders—Clinton and Republican Mitt Romney—are closely associated with proposals to expand coverage.

Romney, as governor of Massachusetts in 2006, signed a law that requires all states residents to obtain health insurance by July 1 of this year, in some cases with government assistance. Clinton, as first lady in the 1990s, largely authored President Bill Clinton's failed universal coverage plan.

While insurance companies were Clinton's opponents a decade ago, they are on her side today—at least in concept. Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), which represents the industry, sent Dingell a letter March 13 generally backing an expansion of SCHIP and efforts to coordinate the public program with private insurance.

"Recognizing that we share common goals in this debate, we stand ready to work with you in building support for constructive legislation that provides quality health insurance for all children," she wrote.

AHIP and other consumer, trade, and interest groups have offered support to several different proposals to expand SCHIP. A bipartisan group of House members, led by Rahm Emanuel, D-Ill., have proposed expanding SCHIP and Medicaid to cover the 6 million children who are estimated to be eligible for public insurance but not enrolled. That proposal would be combined with a new tax credit to encourage middle-income families to buy private insurance for their children.

Emanuel has proposed paying for his plan—which he estimates would cost $60 billion extra over five years—by enacting separate legislation that would improve the collection of capital gains taxes.

Dingell said Emanuel's proposal is "a very useful piece of legislation and we certainly will be looking at it, too."

In the Senate, Finance Chairman Max Baucus, D-Mont., has proposed boosting SCHIP spending by up to $60 billion over the next five years, also with the aim of covering children who are eligible but not enrolled. Gordon H. Smith, R-Ore., who sits on the Senate Finance Committee, has proposed funding an expansion of SCHIP and Medicaid for children by increasing the federal cigarette tax.

Dingell said he did not yet know what his legislation would cost; it is still being scored by the Congressional Budget Office. He also could not say how it would be paid for, but asserted, "I have no doubt we can find savings elsewhere."

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