The State Children’s Health Insurance Program was supposed to be the MVP of various health care policy initiatives in 2007. SCHIP reauthorization, featured widely in conferences, at meetings, and on the Health Affairs Blog, had broad, bipartisan support uniting very strange bedfellows of all political stripes. Nonetheless, two bills for reauthorization were vetoed, and a modest extension keeps the program running for another day.

The original SCHIP bill represented a triumph of bipartisanship led by Sens. Orrin Hatch (R-UT) and Ted Kennedy (D-MA) after years of dispiriting controversies over the Clinton health reforms and budget fights in Congress. Along with several other health care initiatives of the 1990s, it was a hardy offshoot from the failure of comprehensive reforms pushed by the Clinton administration in the early 1990s. Any program with that kind of support and history is tough to keep down. The congressional election in Illinois’ 14th district on March 8 bears witness to phoenix-like qualities of SCHIP.


Even prior to the March election, the SCHIP debate for 2008 had begun to heat up. On February 4, the Bush administration released its new budget. The budget plan included an increase of over $19 billion for five years for SCHIP from what the administration had estimated at the end of 2007, although it still presented a very limited extension of the program.

The revised figures offered by the president last month prompted Sen. Charles Grassley (IA), the ranking Republican on the Senate Finance Committee, to ask when the administration got religion: “I don’t know how or why they revised their estimate by more than 400 percent in a few months. It’s good they got religion, but I wish they’d seen the light last fall. We might have avoided a lot of time and trouble and gotten far better policies instilled in the program.”

Campaigning on SCHIP, Democrats took Hastert’s former seat. Apparently, religion came too late for the Republicans to redeem Illinois’ 14th Congressional District, the home of the retiring former House Speaker, Dennis Hastert, and a district that was carried by President Bush by more than 10 percentage points in 2004. Hastert retired, and a Democratic newcomer named Bill Foster won the seat in a special contest held March 8. Foster’s victory was characterized as a stunning upset by a number of political observers.

For the SCHIP mavens, this congressional race has special appeal since one of the main points hammered home by the Democrats was the lack of support for SCHIP extension by the Republican candidate. The election signals the enduring power and appeal of SCHIP as a political issue going into the 2008 elections, as Rep. Rahm Emanuel — chairman of the Democratic Caucus, who is also from Illinois — promised last spring.

Of course, there is a local spin to all congressional races. The Republican challenger might not have been the strongest candidate. Also, Foster probably benefited from the endorsement of Illinois Senator and Democratic presidential candidate Barrack Obama, as well as help from the Obama camp.

SCHIP is poised to play a key role in this fall’s elections. It seems likely that the message from this race is that SCHIP will again be a key political issue in 2008, whether it is addressed legislatively in another attempt to pass a bipartisan reauthorization or becomes a rallying cry and cudgel for Democrats in key House and Senate races in 2008 (and possibly even in the presidential campaign). Polling on SCHIP by the Kaiser Family Foundation last October found broad support for the reauthorization of SCHIP that was vetoed by President Bush. Vetoes of SCHIP were also supported by presumptive GOP presidential candidate Sen. John McCain (AZ).

The broad support for SCHIP reflects the general U.S. societal norms that value children’s health and access to health care more strongly than adult health and access.

Renewing the spotlight on SCHIP could also have some interesting reverberations in the ongoing Democratic presidential contest between Sen. Hillary Clinton (NY) and Senator Obama. Is there more support for mandating coverage for children (first) or for mandating universal coverage?

Last summer’s and autumn’s SCHIP debate played out before the economy was plunged into $3 a gallon gasoline and the implosion of mortgage and credit markets. The SCHIP debate of 2008 will play out against the worsening economic picture. Texas, a state that has always had a large number of uninsured and underinsured children, now has a record number of 382,000 children eligible for SCHIP.

Other states facing budget shortfalls have taken actions to cap enrollment, like Nevada, or have taken the route of California and Vermont to increase copays and premiums paid by SCHIP enrollees.

The new administrative regulations, implemented by the Centers for Medicare and Medicaid Services in its Friday night stealth directives of August 2007, have also threatened or caused cutbacks in SCHIP enrollment in 23 states at a time when the economy as a whole is in a downturn and employer-sponsored insurance is declining.

Candidates running for election in the House and Senate in 2008 cannot be cheered by the specter of hundreds of thousands of children losing their employer-sponsored insurance and yet not being eligible to obtain private or public insurance because of costs or regulations. As voters in Illinois have demonstrated, a newly uninsured child can be a potent political ad.