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SCHIP--leading off the 2009 Health Care Legislation.

We begin a new year with a new government and a new beginning for many Americans whose hopes and dreams teeter on the edge of a major financial crisis. Following a national celebration of democracy with an inaugural spectacle, we now face the challenging tasks of the days ahead. As we anticipate change with a new president, we face a flood of news reports on the economic woes of industries, businesses, and citizens. Unemployment, foreclosures, stock market distress, and rising costs strangle our confidence for prosperity in the short-term future. In addition, state and local budgets are facing a great fiscal crisis. Of the multiple issues confronting our federal government, health care reform is one of many competing agendas to be addressed. The major health care changes that are so badly needed may not rise to the top of the nation's to-do list.

In the opening days of the 111th Congress, following the first bill introduced to address the national financial disaster (H.R. 1: The American Recovery and Reinvestment Act of 2009), the democratically controlled House and Senate resolved the looming March expiration deadline of the State Children's Health Insurance Program (SCHIP) with H.R. 2: Children's Health Insurance Program Reauthorization Act of 2009. The bill passed the House in one day and passed the Senate with an amendment two weeks later, currently awaiting a conference to resolve differences.

Following a year of political squabbling and a presidential veto, the largely successful SCHIP program will now continue to help low-income children access needed health services and improve their health outcomes. Its reauthorization will pave the way for allowing flexible mechanisms that states may use to strengthen and expand coverage. Unfortunately, funding for health care at the state level will be met with significant state budget deficits that may stifle the potential of assuring quality, affordable health coverage absent additional federal support.

State Budget Woes

According to McNichol and Lav (2009), at least 46 states are facing shortfalls in budgets this year and/or next with combined budget gaps that are estimated to total more than $350 billion to $370 billion in 2010 and 2011. These deficits will impact on Medicaid and other state services. Most states cannot run a deficit or borrow to cover their operating expenses. With the declining revenues from the slumping sales tax and housing market, many states face cutting expenditures. For example, at least 26 states have considered or implemented cuts in low-income children's or families' eligibility for health insurance. While the flexibility of SCHIP implementation serves government well in allowing decision making at the state level, it gives states options in unwanted but necessary reductions in eligibility and enrollment of children that will cramp the intentions or desires to expand coverage. Federal assistance is needed--and we can only hope that the spending efforts in the stimulus plan will find their way to the states to run simultaneously with SCHIP efforts and Medicaid shortfalls.

SCHIP at the Front of the Line

In the flurry of new stimulus spending, the President and Congress will face challenges over priorities that are equally deserving of attention. Although it is a good thing that the focus on uninsured children with SCHIP was early in 2009 and the bipartisan support for children's health insurance was swift, its funding problems may not be resolved as it is engulfed by the larger issues that dampen our efforts for wider health care reform. States have used federal SCHIP funds to finance coverage for children up to 200% to 300% of the federal poverty level when incomes of working uninsured families are too high to qualify for Medicaid (Georgetown University Health Policy Institute: Center for Children and Families, 2008). In the past, some states have taken advantage of the expansions to reach more of their uninsured families. But all state programs today need a miraculous economic recovery or the federal government to adequately supplement the commitments we make to poor children on Medicaid in addition to those served by SCHIP before moving into broader expansions.

Pediatric nurses play a role in the debates related to health care policy, such as Medicaid and SCHIP, as well as their larger citizen's role related to supporting the government's efforts to solve the financial crisis. We need to stay informed and be involved. The issues related to health are inextricably tied to the higher priority of the current fiscal crisis. But we need to keep the torch burning for the children we serve and advocate for SCHIP and Medicaid whenever we can, supporting health care reform that will assure that all children--and their families--get whatever health care they need.

On February 4th, President Obama signed into law H.R. 2, the CHIP reauthorization bill that passed out of the Senate and House with bipartisan support. The new law will result in over 4 million otherwise uninsured children receiving health coverage.


Georgetown University Health Policy Institute: Center for Children and Families. (2008). About SCHIR Retrieved February 4, 2009, from

McNichol, E., & Lav, I. (2009). State budget troubles worsen. Center on Budget and Policy Priorities. Retrieved February 4, 2009, from

Veronica D. Feeg, PhD, RN, FAAN
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Title Annotation:From the Editor; State Children's Health Insurance Program
Author:Feeg, Veronica D.
Publication:Pediatric Nursing
Geographic Code:1USA
Date:Jan 1, 2009
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