Congress targets children's health insurance

WASHINGTON -- Members of both parties in Congress have begun to discuss ways to dramatically expand the decade-old federal health insurance program for children, a debate that could move the nation closer to universal healthcare for children.

With the State Children's Health Insurance Program set to expire Sept. 30, and the program facing an acute funding shortfall that needs to be dealt with by May, legislative leaders and healthcare advocates say the time is right to tackle the issue in a broad way. They are seeking to provide insurance to more of the approximately 9 million children who still lack healthcare coverage in the United States.

Lawmakers are hoping to build on momentum from the final hours of the outgoing Congress, where they took a series of steps to keep 560,000 children, including 40,000 in Massachusetts, from losing healthcare coverage as early as March.

"Congress acted to avert disaster for thousands of low-income children around the nation," said Senator Edward M. Kennedy, a Massachusetts Democrat who is set to become chairman of the Senate Health, Education, Labor and Pensions Committee in January. "But make no mistake -- the action we took was not a permanent solution. Congress must act early in the new year to renew and strengthen CHIP."

Though specific bills won't be filed until after the new Congress convenes in January, several prominent Democrats and Republicans have begun drafting legislation to expand children's healthcare.

Senator John F. Kerry, a Massachusetts Democrat, plans to re-file his bill to guarantee health coverage for all children, through State Children's Health Insurance Program and other programs. Kerry, who said the government could pay for the expansion by repealing tax cuts for the wealthy, had 10 Democratic senators sign on to his measure in the 2005-2006 congressional term, but the bill stalled in committee.

Meanwhile, Senator Olympia J. Snowe, a Maine Republican who serves with Kerry on the Senate Finance Committee and is working on ways to fix this year's looming funding shortfall, believes lawmakers should go further to reduce the number of children who lack healthcare coverage. Snowe said she hopes the discussion will jump-start the national debate over the "crisis of the uninsured."

"We all should agree, irrespective of political party, that every child must have access to healthcare," Snowe said. "I believe that [the program] will be a part of our national debate of finding ways to cover the uninsured."

Any expansion of the program, however, will be expensive, putting more pressure on an already tight federal budget. The current child healthcare program will cost the federal government $5 billion this fiscal year, and just maintaining current levels of service against rising costs and inflation will require at least $12 billion more over the next five years, according to the Center for Budget and Policy Priorities.

One strong Republican supporter of the program, Senator Orrin G. Hatch of Utah, said that before altering the program Congress must first encourage states to enroll all children who are eligible but whose parents have not enrolled them.

Independent studies suggest that as many as 70 percent of uninsured children who meet the income requirements for either Medicaid or the Children's Health Insurance Program are not enrolled in the health plan because their parents have kept them -- either by choice or because they don't know about it.

"My first priority is ensuring that all eligible children are covered under CHIP," Hatch said. "That should be the focus of our efforts in Congress before we debate expanding the program."

The State Children's Health Insurance Program, started in 1997, is a joint state-federal program that provides healthcare coverage to children whose families do not have insurance. Some 4.4 million children are covered under the program this year, including 116,000 in Massachusetts.

Because every state designs its own program and eligibility requirements, some spend their allotments of matching federal dollars more quickly than others. That left Massachusetts, which has a more generous program than most other states, a $55.9 million deficit for the current fiscal year, a situation that would have forced cuts in service without action by Congress last weekend.

Yet that move was a short-term patch that didn't add any new federal money. Instead, it allowed money to be transferred from states with extra cash in their children's health accounts to states that are about to run out of money.

Congress will have to come up with another $700 million to cover additional state shortfalls in the program this year, and Democrats are promising to revisit that issue when they take control of Congress in January.

The prospect of children losing healthcare could quicken the pace in Congress, said John McDonough , a former Massachusetts state lawmaker who is executive director of the advocacy group Health Care for All.

"2007 is the year that something has to happen on children's health," McDonough said. "There are a lot of folks who are saying, 'This is a chance to finish the job.' "

House speaker-designate Nancy Pelosi has committed to providing more healthcare coverage to children, but has not detailed what level of spending she would be comfortable with. One obstacle that could hamstring Democrats is their commitment to follow "pay-as-you-go" budgeting rules, which require any increase in spending to be offset by a budget cut or additional revenue.