Children's Health Insurance Program Reauthorization Act Of 2009
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The Children's Health Insurance Program (CHIP) – formerly known as the State Children's Health Insurance Program (SCHIP) – is a program administered by the
United States Department of Health and Human Services The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
that provides
matching funds Matching funds are funds that are set to be paid in proportion to funds available from other sources. Matching fund payments usually arise in situations of charity or public good. The terms cost sharing, in-kind, and matching can be used interc ...
to states for
health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
to families with children. The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for
Medicaid Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and pers ...
. The program was passed into law as part of the
Balanced Budget Act of 1997 The Balanced Budget Act of 1997 () was an omnibus legislative package enacted by the United States Congress, using the budget Reconciliation (U.S. Congress), reconciliation process, and designed to balance the federal budget by 2002. This act wa ...
, and the statutory authority for CHIP is under title XXI of the
Social Security Act The Social Security Act of 1935 is a law enacted by the 74th United States Congress and signed into law by US President Franklin D. Roosevelt. The law created the Social Security program as well as insurance against unemployment. The law was pa ...
. CHIP was formulated in the aftermath of the failure of President
Bill Clinton William Jefferson Clinton ( né Blythe III; born August 19, 1946) is an American politician who served as the 42nd president of the United States from 1993 to 2001. He previously served as governor of Arkansas from 1979 to 1981 and agai ...
's comprehensive health care reform proposal. Legislation to create CHIP was co-sponsored by Democratic Senator
Ted Kennedy Edward Moore Kennedy (February 22, 1932 – August 25, 2009) was an American lawyer and politician who served as a United States senator from Massachusetts for almost 47 years, from 1962 until his death in 2009. A member of the Democratic ...
and
Republican Republican can refer to: Political ideology * An advocate of a republic, a type of government that is not a monarchy or dictatorship, and is usually associated with the rule of law. ** Republicanism, the ideology in support of republics or agains ...
Senator
Orrin Hatch Orrin Grant Hatch (March 22, 1934 – April 23, 2022) was an American attorney and politician who served as a United States senator from Utah from 1977 to 2019. Hatch's 42-year Senate tenure made him the longest-serving Republican U.S. senator ...
, and received strong support from First Lady
Hillary Clinton Hillary Diane Rodham Clinton ( Rodham; born October 26, 1947) is an American politician, diplomat, and former lawyer who served as the 67th United States Secretary of State for President Barack Obama from 2009 to 2013, as a United States sen ...
. Despite opposition from some conservatives, SCHIP was included in the Balanced Budget Act of 1997, which President Clinton signed into law in August 1997. At the time of its creation, SCHIP represented the largest expansion of taxpayer-funded health insurance coverage for children in the U.S. since the establishment of
Medicaid Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and pers ...
in 1965. The Children's Health Insurance Reauthorization Act of 2009 extended CHIP and expanded the program to cover an additional 4 million children and pregnant women, and the
Bipartisan Budget Act of 2018 The Bipartisan Budget Act of 2018 is a federal statute concerning spending and the budget in the United States, that was signed into law by President Donald Trump on February 9, 2018. Delays in the passage of the bill caused a nine-hour fundi ...
extended CHIP's authorization through 2027. CHIP was designed as a federal-state partnership similar to
Medicaid Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and pers ...
; programs are run by the individual states according to requirements set by the federal
Centers for Medicare and Medicaid Services The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...
. States are given flexibility in designing their CHIP policies within broad federal guidelines, resulting in variations regarding eligibility, benefits, and administration across different states. Many states contract with private companies to administer some portions of their CHIP benefits. Some states have received authority to use CHIP funds to cover certain adults, including pregnant women and parents of children receiving benefits from both CHIP and Medicaid. CHIP covered 7.6 million children during federal fiscal year 2010, and every state has an approved plan. Nonetheless, the number of uninsured children continued to rise after 1997, particularly among families that did not qualify for CHIP. An October 2007 study by the Vimo Research Group found that 68.7 percent of newly uninsured children were in families whose incomes were 200 percent of the
federal poverty level In the United States, poverty has both social and political implications. In 2020, there were 37.2 million people in poverty. Some of the many causes include income inequality, inflation, unemployment, debt traps and poor education.Western, B ...
or higher as more employers dropped dependents or dropped coverage altogether due to annual premiums nearly doubling between 2000 and 2006. A 2007 study from researchers at Brigham Young University and Arizona State found that children who drop out of CHIP cost their states more money due to the increased use of emergency care. A 2018 survey of the existing research noted that the availability of "CHIP coverage for children has led to improvements in access to health care and to improvements in health over both the short-run and the long-run."


History

The Children's Health Insurance Program grew out of years of work in the
U.S. Congress The United States Congress is the legislature of the federal government of the United States. It is Bicameralism, bicameral, composed of a lower body, the United States House of Representatives, House of Representatives, and an upper body, ...
to improve Americans' health coverage. Almost a decade prior, the
U.S. Bipartisan Commission on Comprehensive Health Care The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...
was formed in 1989 and charged with recommending “legislative action to ensure coverage for all Americans.” The Commission, renamed the Pepper Commission in honor of its creator and first chair Representative Claude Pepper (D-Fla.), laid out a blueprint to achieve universal coverage. Given the challenges of comprehensive health reform, Governor
Jay Rockefeller John Davison "Jay" Rockefeller IV (born June 18, 1937) is a retired American politician who served as a United States senator from West Virginia (1985–2015). He was first elected to the Senate in 1984, while in office as governor of West Virg ...
, who was elected chair following Rep. Pepper's death, emphasized his commitment to pursue legislative action not only on the commission's full set of recommendations but also on a "down payment"—to expand public health coverage immediately for children and pregnant women, consistent with the principles the commission put forward. The legislation would guarantee public insurance coverage through Medicaid for every American child living in poverty and offset the cost of the improvements by doubling the federal excise tax on cigarettes. Quickly after his election in 1992, President
Bill Clinton William Jefferson Clinton ( né Blythe III; born August 19, 1946) is an American politician who served as the 42nd president of the United States from 1993 to 2001. He previously served as governor of Arkansas from 1979 to 1981 and agai ...
assembled a task force to write a comprehensive health reform bill, and he worked with Congress to introduce the Health Security Act (HSA) in November 1993. It included provisions such as universal coverage and a basic benefit package, health insurance reform, and consumer choice of health plans. After the HSA failed in the fall of 1994, congressional leaders and the administration recognized the need for an incremental, bipartisan approach to health care reform. Senator
Jay Rockefeller John Davison "Jay" Rockefeller IV (born June 18, 1937) is a retired American politician who served as a United States senator from West Virginia (1985–2015). He was first elected to the Senate in 1984, while in office as governor of West Virg ...
continued to argue for expanded coverage for children. He referenced an amendment for accelerated coverage children and pregnant women offered during the Senate Finance Committee’s health care reform markup that was adopted by a bipartisan majority of 12 to 8 as evidence that there was bipartisan support to provide assistance to children. He also went on to say expanding coverage for children was essential to reforming the welfare system to “prevent families from having to go and off welfare to qualify for Medicaid.” The 1996 Bipartisan Budget Agreement made net reductions in federal Medicaid spending over a five-year period but anticipated an additional $16 billion in spending on children's health care over the same period. However, it did not provide details on how that money would be spent. In 1997, several members of Congress introduced bills to cover uninsured children using that $16 billion, and the two most popular proposals were the Chafee-Rockefeller proposal and the Kennedy-Hatch proposal. Senator
Ted Kennedy Edward Moore Kennedy (February 22, 1932 – August 25, 2009) was an American lawyer and politician who served as a United States senator from Massachusetts for almost 47 years, from 1962 until his death in 2009. A member of the Democratic ...
, Chairman of the Senate Committee on Health, Education, Labor, and Pensions (HELP) was intrigued by a children's health insurance plan in Massachusetts that had passed in 1996, and met with a
Boston Medical Center Boston Medical Center (BMC) is a non-profit 514-bed academic medical center in Boston, Massachusetts. It is the largest safety-net hospital and Level I trauma center in New England. BMC employs 1,466 physicians—including 711 residents and f ...
pediatrics director and a Massachusetts state legislator to discuss the feasibility of a national initiative. Kennedy also saw using an increase in
tobacco taxes Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is believed ...
as a way to pay for the expanded coverage. Thus, in October 1996, Kennedy introduced a bill to provide health care coverage for children of the working poor, to be financed via a 75 cents a pack cigarette tax increase. Kennedy brought Republican Senator
Orrin Hatch Orrin Grant Hatch (March 22, 1934 – April 23, 2022) was an American attorney and politician who served as a United States senator from Utah from 1977 to 2019. Hatch's 42-year Senate tenure made him the longest-serving Republican U.S. senator ...
onto the legislation as a co-sponsor. Kennedy and Hatch had worked together as an "odd couple" in the Senate before, and here Hatch said that "Children are being terribly hurt and perhaps scarred for the rest of their lives" and that "as a nation, as a society, we have a moral responsibility" to provide coverage. Hatch's role would infuriate some Republican colleagues and conservative commentators. On April 8, 1997, Senators Kennedy and Hatch introduced S. 525, the “Child Health Insurance and Lower Deficit Act (CHILD). This legislation amended the Public Health Service Act to create a new grant program for states to purchase private health insurance for children. It proposed to raise $30 billion over 5 years by raising the tobacco tax with $20 billion going to expanded coverage for children under a block grant approach and $10 billion for deficit reduction. S. 525 was referred to the Senate Health Education Labor and Pensions (HELP) Committee. Hearings were held on the bill in the HELP Committee but legislation to expand coverage for children was never acted on in the HELP Committee. On April 30, 1997, Senators
John Chafee John Lester Hubbard Chafee ( ; October 22, 1922 – October 24, 1999) was an American politician and officer in the United States Marine Corps. A member of the Republican Party (United States), he served as the 66th Governor of Rhode Island, as ...
(R-RI) and
Jay Rockefeller John Davison "Jay" Rockefeller IV (born June 18, 1937) is a retired American politician who served as a United States senator from West Virginia (1985–2015). He was first elected to the Senate in 1984, while in office as governor of West Virg ...
(D-WVa.) introduced S. 674, a bill to amend title XIX of the Social Security Act “to expand health coverage of low income children and pregnant women and to provide funds to promote outreach efforts to enroll eligible children.” On the same day, Representative
John Dingell John David Dingell Jr. (July 8, 1926 – February 7, 2019) was an American politician who served as a member of the United States House of Representatives from 1955 until 2015. A member of the Democratic Party, he holds the record for longest ...
(D-MI) introduced an identical bipartisan companion bill in the
House of Representatives House of Representatives is the name of legislative bodies in many countries and sub-national entitles. In many countries, the House of Representatives is the lower house of a bicameral legislature, with the corresponding upper house often c ...
with Republican cosponsor, Representative Margaret Scafati Roukema (R-NJ). Meanwhile, in December 1996 First Lady Hillary Rodham Clinton examined several possible initiatives and decided expanding health care insurance to children who had none was the one to advance, especially as its focus on children would be politically popular. This had precedents from earlier in the Clinton administration: a different variant of this approach, dubbed "Kids First", had been envisioned as a backup plan during the original 1993 Task Force on National Health Care Reform meetings. Additionally, Hillary Clinton had discussed an SCHIP-like program with a White House health policy coordinator during the time her full-blown health care plan had suffered political failure. The new initiative was proposed at Bill Clinton's January 1997
State of the Union address The State of the Union Address (sometimes abbreviated to SOTU) is an annual message delivered by the president of the United States to a joint session of the United States Congress near the beginning of each calendar year on the current conditio ...
, with the stated goal of coverage up to five million children. Kennedy continued to write much of the bill, using the increase in tobacco taxes to pay the $20 billion price tag. In March 1997, Kennedy brought Republican Senator Orrin Hatch onto the legislation as co-sponsor; Kennedy and Hatch had worked together as an "odd couple" in the Senate before, and here Hatch said that "Children are being terribly hurt and perhaps scarred for the rest of their lives" and that "as a nation, as a society, we have a moral responsibility" to provide coverage. Hatch's role would infuriate some Republican colleagues and conservative commentators. The First Lady did not hold news conferences or testify before Congress on behalf of the bill. An initial objection of Republicans in the Senate was that proposing to pay for the services by raising the federal tax on cigarettes, from 24 cents a pack to 67 cents a pack, ignored the likely consequence that sale of tobacco products would decrease and tax revenues would increasingly fall short of those needed to pay for the expansion of benefits. Kennedy and Hatch scoffed at the objection, with the former saying, "If we can keep people healthy and stop them from dying, I think most Americans would say 'Amen; isn't that a great result?' If fewer people smoke, states will save far more in lower health costs than they will lose in revenues from the cigarette tax." Republicans also criticized the bill as an open-ended
entitlement program Social programs in the United States are programs designed to ensure that the basic needs of the American population are met. Federal and state social programs include cash assistance, health insurance, food assistance, housing subsidies, en ...
, although it was structured as a
block grant A block grant is a grant-in-aid of a specified amount from a larger government to a smaller regional government body. Block grants have less oversight from the larger government and provide flexibility to each subsidiary government body in terms ...
rather than an entitlement; Senate Majority Leader
Trent Lott Chester Trent Lott Sr. (born October 9, 1941) is an American lawyer, author, and politician. A former United States Senator from Mississippi, Lott served in numerous leadership positions in both the United States House of Representatives and the ...
was an early opponent of the measure, calling it a "big-government program" that would not pass. Pressure was on to reduce the amount of grants involved, with $16 billion a possible compromise; Hillary Clinton instead argued for $24 billion. The Clinton administration had a deal with the Republican leadership in Congress that forbade the administration from backing any amendments to the budget resolution. On May 22, it was so done, with the necessary cigarette tax amendment defeated by a 55–45 margin. but Kennedy was surprised and angered by it, considering it a betrayal, and saying that his calls to Bill Clinton and Vice President
Al Gore Albert Arnold Gore Jr. (born March 31, 1948) is an American politician, businessman, and environmentalist who served as the 45th vice president of the United States from 1993 to 2001 under President Bill Clinton. Gore was the Democratic Part ...
had not been returned. Hatch was also upset, saying that Lott may have been bluffing and that, "I think the President and the people in the White House caved here." Kennedy did not give up on the measure, saying: "We shall offer it again and again until we prevail. It's more important to protect children than to protect the tobacco industry." Both Bill and Hillary Clinton argued for including the children's health insurance in subsequent legislation. The bill was indeed revived by Kennedy and Hatch a month after its initial defeat. Organizations from the
Children's Defense Fund The Children's Defense Fund (CDF) is an American 501(c)(3) nonprofit organization based in Washington, D.C., that focuses on child advocacy and research. It was founded in 1973 by Marian Wright Edelman. History The CDF was founded in 1973, citi ...
to the
Girl Scouts of the USA Girl Scouts of the United States of America (GSUSA), commonly referred to as simply Girl Scouts, is a youth organization for girls in the United States and American girls living abroad. Founded by Juliette Gordon Low in 1912, it was organized a ...
lobbied for its passage, putting public pressure on Congress; Kennedy urged Clinton to use her influence within the White House. SCHIP was then passed and signed into law by Bill Clinton on August 5, 1997 as part of the
Balanced Budget Act of 1997 The Balanced Budget Act of 1997 () was an omnibus legislative package enacted by the United States Congress, using the budget Reconciliation (U.S. Congress), reconciliation process, and designed to balance the federal budget by 2002. This act wa ...
, to take effect the following month. At a press conference following the signing, Kennedy thanked Hatch, Senate Minority Leader
Tom Daschle Thomas Andrew Daschle ( ; born December 9, 1947) is an American politician and lobbyist who served as a United States senator from South Dakota from 1987 to 2005. A member of the Democratic Party, he became U.S. Senate Minority Leader in 1995 an ...
, Children's Defense Fund head
Marian Wright Edelman Marian Wright Edelman (born June 6, 1939) is an American activist for civil rights and children's rights. She is the founder and president emerita of the Children's Defense Fund. She influenced leaders such as Martin Luther King Jr. and Hillary ...
, Bill Clinton, and Hillary Clinton. About the last, Kennedy said, "Mrs. Clinton ... was of invaluable help, both in the fashioning and the shaping of the program and also as a clear advocate." CHIP is located at Title IV, subtitle J of H.R. 2015 05th
Balanced Budget Act of 1997 The Balanced Budget Act of 1997 () was an omnibus legislative package enacted by the United States Congress, using the budget Reconciliation (U.S. Congress), reconciliation process, and designed to balance the federal budget by 2002. This act wa ...
. H.R. 2015 was introduced and sponsored by Rep John Kasich -OHwith no cosponsors. On 25 June 1997, H.R. 2015 passed House Vote Roll #241 mainly among partisan lines, 270 ayes and 162 nays, with most Democrats in the House of Representatives in opposition. On the same day, the bill passed in the Senate, with a substitute amendment, by unanimous consent. After a conference between the House and Senate, passage in both House (Roll #345: 346-85) and Senate (Roll #209: 85-15) on the conference substitute became more bipartisan.


State administration

Like Medicaid, CHIP is a partnership between federal and state governments. The programs are run by the individual states according to requirements set by the federal
Centers for Medicare and Medicaid Services The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...
. States may design their CHIP programs as an independent program separate from Medicaid (separate child health programs), use CHIP funds to expand their Medicaid program (CHIP Medicaid expansion programs), or combine these approaches (CHIP combination programs). States receive enhanced federal funds for their CHIP programs at a rate above the regular Medicaid match. By February 1999, 47 states had set up CHIP programs, but it took effort to get children enrolled. That month, the Clinton administration launched the "Insure Kids Now" campaign, designed to get more children enrolled; the campaign would fall under the aegis of the
Health Resources and Services Administration The Health Resources and Services Administration (HRSA) is an agency of the U.S. Department of Health and Human Services located in North Bethesda, Maryland. It is the primary federal agency for improving access to health care services for peop ...
. By April 1999, some 1 million children had been enrolled, and the Clinton administration set a goal of raising the figure to 2.5 million by 2000. States with separate child health programs follow the regulations described in Section 42 of the Code of Federal Regulations, Section 457. Separate child health programs have much more flexibility than Medicaid programs. Separate programs can impose cost sharing, tailor their benefit packages, and employ a great deal of flexibility in eligibility and enrollment matters. The limits to this flexibility are described in the regulations, and states must describe their program characteristics in their CHIP state plans. Out of 50 state governors, 43 support CHIP renewal. Some states have incorporated the use of private companies to administer portions of their CHIP benefits. These programs, typically referred to as
Medicaid managed care Medicaid managed care Medicaid and additional services in the United States through an arrangement between a state Medicaid agency and managed care organizations (MCOs) that accept a set payment – "capitation" – for these services. As of 2014, ...
, allow private insurance companies or health maintenance organizations to contract directly with a state Medicaid department at a fixed price per enrollee. The health plans then enroll eligible individuals into their programs and become responsible for assuring CHIP benefits are delivered to eligible beneficiaries. In
Ohio Ohio () is a state in the Midwestern region of the United States. Of the fifty U.S. states, it is the 34th-largest by area, and with a population of nearly 11.8 million, is the seventh-most populous and tenth-most densely populated. The sta ...
, CHIP funds are used to expand eligibility for the state's Medicaid program. Thus all Medicaid rules and regulations (including cost sharing and benefits) apply. Children from birth through age 18 who live in families with incomes above the Medicaid thresholds in 1996 and up to 200% of the federal poverty level are eligible for the CHIP Medicaid expansion program. In 2008, the maximum annual income needed for a family of four to fall within 100% of the federal poverty guidelines was $21,200, while 200% of the poverty guidelines was $42,400. Other states have similar CHIP guidelines, with some states being more generous or restrictive in the number of children they allow into the program. With the exception of Alaska, Idaho, North Dakota and Oklahoma, all states have a minimum threshold for coverage at 200% of the federal poverty guidelines. North Dakota currently has the lowest at 175%. New York currently has the highest at 405% of the federal poverty guidelines. CHIP Medicaid expansion programs typically use the same names for the expansion and Medicaid programs. Separate child health programs typically have different names for their programs. A few states also call the CHIP program by the term "Children's Health Insurance Program" (CHIP). States are allowed to use Medicaid and CHIP funds for premium assistance programs that help eligible individuals purchase private health insurance. As of 2008 relatively few states had premium assistance programs, and enrollment was relatively low. Interest in this approach remained high, however. In August 2007, the Bush Administration announced a rule requiring states (as of August 2008) to sign up 95% of families with children earning 200% of the federal poverty level, before using the funds to serve families earning more than 250% of the federal poverty level. The federal government said that 9 out the 17 states that offer benefits to higher-earning families were already compliant. Opponents of this rule argued that signing up higher-income families makes lower-income families more likely to sign up, and that the rule was incompassionate toward children who would otherwise go without medical insurance.


Implementations

* California:
California Healthy Families Program The California Healthy Families Program (HFP) was the California implementation of the federal Children's Health Insurance Program (CHIP) that provided low-cost insurance offering health, dental, and vision coverage to children without insurance tha ...
* Utah:
State Children's Health Insurance Program in Utah Following the signing of the Children’s Health Insurance Program (CHIP) into law on August 5, 1997, as Title XXI of the Social Security Act, Utah started looking at how to implement the Federal program under the Center for Medicare and Medicaid Se ...


Impact

A 2018 survey of the existing research noted that the availability of "CHIP coverage for children has led to improvements in access to health care and to improvements in health over both the short-run and the long-run." In 2007, researchers from
Brigham Young University Brigham Young University (BYU, sometimes referred to colloquially as The Y) is a private research university in Provo, Utah. It was founded in 1875 by religious leader Brigham Young and is sponsored by the Church of Jesus Christ of Latter-day ...
and
Arizona State Arizona State University (Arizona State or ASU) is a public research university in the Phoenix metropolitan area. Founded in 1885 by the 13th Arizona Territorial Legislature, ASU is one of the largest public universities by enrollment in the ...
found that children who drop out of CHIP cost states more money because they shift away from routine care to more frequent
emergency care Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (often called “ER doctors” in the United States) continuously learn to care for unsche ...
situations. The conclusion of the study is that an attempt to cut the costs of a state healthcare program could create a false savings because other government organizations pick up the tab for the children who lose insurance coverage and later need care. In a 2007 analysis by the
Congressional Budget Office The Congressional Budget Office (CBO) is a federal agency within the legislative branch of the United States government that provides budget and economic information to Congress. Inspired by California's Legislative Analyst's Office that manages ...
, researchers determined that "for every 100 children who gain coverage as a result of CHIP, there is a corresponding reduction in private coverage of between 25 and 50 children." The CBO speculates this is because the state programs offer better benefits at lower cost to enrollees than the private alternatives. A briefing paper by libertarian think-tank
Cato Institute The Cato Institute is an American libertarian think tank headquartered in Washington, D.C. It was founded in 1977 by Ed Crane, Murray Rothbard, and Charles Koch, chairman of the board and chief executive officer of Koch Industries.Koch Indust ...
estimated the "crowding out" of private insurers by the public program could be as much as 60%.


Reauthorization

SCHIP was created in 1997 as a ten-year program; to continue past federal fiscal year 2007, passage of a reauthorization bill was required. The first two reauthorization bills to pass through Congress would also expand the program's scope; President
George W. Bush George Walker Bush (born July 6, 1946) is an American politician who served as the 43rd president of the United States from 2001 to 2009. A member of the Republican Party, Bush family, and son of the 41st president George H. W. Bush, he ...
vetoed them as improper expansions. A two-year reauthorization bill was signed into law by the President in December 2007 that would merely extend current CHIP services without expanding any portion of the program. With the 2008 Presidential and Congressional elections giving Democrats control of the Oval Office as well as expanded majorities in both houses of Congress, CHIP was reauthorized and expanded in the same bill through fiscal year 2013.


2007 reauthorization


HR 976

In 2007, both houses of Congress passed a bipartisan measure to expand the CHIP program, . The measure would have expanded coverage to over 4 million more participants by 2012, while phasing out most state expansions in the program that include any adults other than pregnant women. The bill called for a budget increase for five years totaling $35 billion, increasing total CHIP spending to $60 billion for the five-year period. Opposition to HR 976 focused on the $35 billion increase in government health insurance as well as $6.5 billion in Medicaid benefits to illegal immigrants. Originally intended to provide health care coverage to low-income children, HR 976 was criticized as a giveaway that would have benefited adults as well as non-U.S. citizens. The program expansion was to have been funded by sharply increasing federal excise taxes on tobacco products. On the other hand, opponents said this proposed expansion was for families with annual incomes up to $82,600 (400 percent of the federal poverty level) On October 3, 2007, President Bush vetoed the bill, stating that he believed it would "federalize health care", expanding the scope of CHIP much farther than its original intent. The veto was the fourth of his administration. After his veto, Bush said he was open to a compromise that would entail more than the $5 billion originally budgeted, but would not agree to any proposal drastically expanding the number of children eligible for coverage. On October 18, 2007, the House of Representatives fell 13 votes short (273–156) of the two-thirds majority required to override the president's veto, although 44 Republicans joined 229 Democrats in supporting the measure.


HR 3963

Within a week of the failed veto override vote, the House passed a second bill attempting a similar expansion of CHIP. According to Democrats, the second bill, , created firmer caps on income eligibility, prevented adults from joining, and banned children of illegal immigrants from receiving benefits. According to its opponents, however, this second proposed expansion was for families with annual incomes up to $62,000 (300 percent of the federal poverty level). The Senate passed the measure on November 1, 2007, but on December 12, 2007, Bush vetoed this bill as well, saying it was "essentially identical" to the earlier legislation, and a House vote in January 2008 failed to override the veto. , which extended CHIP funding through March 31, 2009, and the President signed it into law on December 21, 2007. The reauthorization bill also changed the program's name from "SCHIP" to simply "CHIP"


2009 reauthorization

In the wake of President
Barack Obama Barack Hussein Obama II ( ; born August 4, 1961) is an American politician who served as the 44th president of the United States from 2009 to 2017. A member of the Democratic Party, Obama was the first African-American president of the U ...
's inauguration and the Democrats' increased majorities in both houses of Congress, legislative leaders moved quickly to break the political stalemate over CHIP expansion. On January 14, 2009, the House passed on a vote of 290-138. The bill authorized spending and added $32.8 billion to expand the health coverage program to include about 4 million more children, including coverage of legal immigrants with no waiting period for the first time. A cigarette tax increase of 62 cents—bringing the total tax on a pack of cigarettes to $1.01—an increase of tax on chewing tobacco from $0.195/lb. to $0.50/lb.—as well as tax increases on other tobacco products was proposed as a funding source for the program's expansion. On January 29, the Senate passed the House bill by a 66-32 margin, with two amendments. The House accepted the amended version on a vote of 290 to 135, and President Obama signed the bill into law as on February 4, 2009.


2010 funding via Patient Protection and Affordable Care Act

The 2010 passage and signing of the
Patient Protection and Affordable Care Act The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by Presi ...
included funding for CHIP through 2015.


2015 reauthorization

In 2015, Congress passed the
Medicare Access and CHIP Reauthorization Act of 2015 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), (, ) commonly called the Permanent Doc Fix, is a United States statute. Revising the Balanced Budget Act of 1997, the Bipartisan Act was the largest scale change to the American health c ...
(MACRA), and it was signed by President Obama.


2017 expiration and 2018 reauthorization for 6 additional years

CHIP expired on September 30, 2017. At the time, most states had sufficient funds to keep the program running for a period of months. On September 18, 2017, Senators
Orrin Hatch Orrin Grant Hatch (March 22, 1934 – April 23, 2022) was an American attorney and politician who served as a United States senator from Utah from 1977 to 2019. Hatch's 42-year Senate tenure made him the longest-serving Republican U.S. senator ...
and
Ron Wyden Ronald Lee Wyden (; born May 3, 1949) is an American politician and retired educator serving as the Seniority in the United States Senate, senior United States Senate, United States senator from Oregon, a seat he has held since 1996 United Stat ...
introduced the Keeping Kids’ Insurance Dependable and Secure (KIDS) Act (Bill S.1827), which would fund CHIP until 2022. On November 3, 2017, the House of Representatives passed the CHAMPION Act, which also would fund CHIP until 2022. On January 22, 2018, President Trump signed legislation that reauthorized CHIP for six years. Bill H.195 (known as the Federal Register Printing Savings Act of 2017, including Extension of Continuing Appropriations Act, 2018) passed the House by a vote of 266-150 and passed the Senate a vote of 81-18. Fifteen Senate Democrats and 144 House Democrats voted against the bill because they objected to ending a three-day government shutdown without legally enshrining the DACA program for certain undocumented immigrants. On February 9, 2018, Congress passed the
Bipartisan Budget Act of 2018 The Bipartisan Budget Act of 2018 is a federal statute concerning spending and the budget in the United States, that was signed into law by President Donald Trump on February 9, 2018. Delays in the passage of the bill caused a nine-hour fundi ...
, which reauthorized CHIP for an additional four years. The bill was passed by vote of 71–28 in the Senate and by a vote of 240–186 in the House of Representatives. President Trump signed the bill into law that same day, allowing for CHIP's extension through 2027.


See also

*
Cigarette taxes in the United States In the United States, cigarettes are taxed at both the federal and state levels, in addition to any state and local sales taxes and local cigarette-specific taxes. Cigarette taxation has appeared throughout American history and is still a contes ...
* Graeme Frost *
Health insurance in the United States Health insurance in the United States is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include ...
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PeachCare PeachCare for Kids is a low-cost health insurance program for children of uninsured, low-income families in the U.S. state of Georgia (U.S. state), Georgia who do not qualify for Medicaid. It is operated by the Georgia Department of Community Healt ...
* TexCare


References


Sources

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External links


CHIP at the Centers for Medicare & Medicaid Services



Georgetown University Center for Children and Families resources on SCHIP
{{Hillary Clinton Children's health in the United States Medicare and Medicaid (United States) United States federal health legislation 110th United States Congress 111th United States Congress