Senate Votes To Begin Debate On SCHIP Reauthorization

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State Children's Health Insurance Program

Senate on Monday voted 80-0 to begin debate on legislation (S 1893) that would reauthorize SCHIP and expand funding for the program by $35 billion over five years, CongressDaily reports (Johnson, CongressDaily, 7/31). SCHIP expires on Sept. 30.

The Senate Finance Committeeon July 13 finalized an agreement on SCHIP reauthorization that wouldincrease five-year funding for the program from $25 billion to $60billion by raising the federal cigarette tax from 39 cents to $1 perpack. Under the plan, the 6.6 million children currently enrolled inSCHIP would continue to receive benefits, and an additional 3.3 millionchildren could be enrolled in the program (Kaiser Daily Health Policy Report, 7/20).

The Senate bill would allow states to enroll pregnant women but would exclude undocumented immigrants (CongressDaily,7/31). President Bush on Monday issued a formal veto threat against theSenate legislation. Bush has proposed a $5 billion increase over fiveyears for SCHIP, which would raise the program's total five-yearfunding to $30 billion (Donnelly, Boston Globe,7/31). A Statement of Administrative Policy issued by the White Housesaid that the Senate bill "essentially extends a welfare benefit tomiddle-class households." In addition, the administration takes issuewith the proposed exclusion of pregnant undocumented immigrants becausethe bill "wrongly weakens the current option available to states tocover unborn children and their mothers," according to the SAP. Undercurrent policy, states may allow pregnant undocumented immigrants toenroll in SCHIP to receive prenatal and delivery services because theirchildren will be U.S. citizens (CongressDaily, 7/31). Asecond cloture vote later this week might be necessary to end debateand move to vote on the legislation, according to CongressDaily (Johnson, CongressDaily, 7/30).

House Developments

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Meanwhile, House Democrats on Monday reached an agreement on revisions to SCHIP legislation (HR 3162) that would enable the bill to meet budgetary pay/go requirements, CQ Today reports (Wayne, CQ Today, 7/30). A preliminary scoring by the Congressional Budget Office found that over the next 10 years, the bill marked up by the House Energy and Commerce Committee would have a deficit of $90 billion, most of which would occur in the second half of that time period. The House Ways and Means Committeebill would have a $76 billion deficit in a decade, all of which wouldoccur in the second half of that time period, according to CBO DirectorPeter Orszag (Kaiser Daily Health Policy Report, 7/27).

Tomeet the pay/go guidelines, Democrats agreed to reduce the amount offunding allotted for bonuses to states for enrolling children in SCHIP.Lawmakers also agreed to limit to two years plans to reverse scheduledcuts in Medicare payments to physicians, according to a House aide.Funding for state bonuses would not be affected in the first fiveyears, and subsequent reductions would be based on the notion that the"goal of improving enrollment in the program will have been achieved bythe time the bonuses are scaled back," according to CQ Today (CQ Today, 7/30).

The House Rules Committeebefore the August recess this week is scheduled to combine the billsapproved in the House Ways and Means Committee and the House Energy andCommerce Committee for floor consideration (Young, The Hill, 7/31).

Latest Scoring

The latest scoring documents from CBO estimate that the House SCHIPlegislation would cost $47.8 billion over five years and $159.9 billionover 10 years, CQ HealthBeatreports. The scoring includes figures for the years 2008-2012 and2008-2017. Reversal of a scheduled payment cut to physicians in 2008and 2009 would cost $20.1 billion over five years, including the costsof a 0.5% increase for those two years. The 10-year cost of thereversal of cuts for those two years is $101 billion, according to CBO.

The scoring also determined that House cuts to MedicareAdvantage plans would result in a decline in expenditures of $50.4billion over five years and $157.1 billion over 10 years. All cuts toMedicare included by the bill would total $194.8 billion over 10 years.However, it is "unclear" how closely the scoring document reflects theprovisions on which lawmakers will vote, according to CQ HealthBeat. It also is unknown whether House lawmakers will make deeper cuts or pay for the bill over five years, CQ HealthBeat notes (Reichard, CQ HealthBeat, 7/30).

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Reprinted with permission fromkaisernetwork.org.You can view the entire KaiserDaily Health Policy Report, search the archives, andsign up for email delivery at kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published forkaisernetwork.org,a free service of The Henry J. Kaiser Family Foundation.

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