House Passes SCHIP Reform, but States Still Need Help on Insuring ALL Kids

Last night, the US House of Representatives passed H.R. 2, an expansion of SCHIP, a federal program that provides medical insurance to lower income children, across strong bipartisan lines (289-139) with forty Republicans voting in favor of the bill. SCHIP currently covers 6.7 million kids and expansion will allow an additional 4 million.

The House version of the bill removes a 5-year waiting period for children and pregnant women who are legal immigrants, a provision that children's advocates and health care providers agree is important for public health and child development.  While the current Senate version of the bill lacks coverage for immigrant children, House Speaker Pelosi expects Obama to sign the House version of the bill. Congress had passed SCHIP expansion twice under President Bush, who had vetoed it both times, despite broad public support for providing children's health care. A poll taken at the end of 2008 found that 67% of respondents favored expanding SCHIP to ensure that all children in America, including legal immigrant children, have health care coverage, with only 15% opposed.  

Up to this point states have been taking up the slack in establishing coverage for immigrant children.  As of late 2006, 21 states and the District of Columbia provided some form of health coverage for legal immigrant children and pregnant women excluded by the 5 year federal SCHIP bar or from Medicaid.

Even with the proposed change, the SCHIP program will still leave out undocumented children, driving up health care costs for states and local governments that leads to delayed care and expensive emergency room visits.  Iowa legislators plan to introduce a bill to cover undocument children under a plan to cover all kids in the state by 2011.  As Iowa state Senators Jack Hatch and Joe Bolkcom write in a recent Des Moines Register editorial:

We are already providing health services to undocumented children in the emergency rooms of our community hospitals. This is the single most expensive venue to provide health-care services. It is far more cost-effective to provide care in an organized fashion. When our emergency-room doctors and nurses render primary care to undocumented children, it diverts these doctors from rendering emergency care to others in our community.

Moreover, emergency-room pediatricians often find themselves in an untenable situation when caring for an undocumented child who needs expensive, life-saving care. Their role as a physician and patient advocate leads to conflict between the need to provide care and the need of the health-care institution they work with to remain financially solvent. Significant ethical and public-health consequences result when we deny needed care to these children.

Iowa would be joining other states including District of Columbia, New York, Illinois, Massachsuetts, and Washington States in providing health care to all children, regardless of status. Some cities such as New York and San Francisco have gone to even greater lengths to ensure that all their residents, including undocumented adult immigrants, can have access to health care. 

The idea of making the most effective use of state health care dollars by insuring coverage and preventative care for undocumented immigrants versus paying for ER visits, which are more expensive, has also received support from Republican Governor Arnold Schwartzenegger of California. Medical studies have also substantiated the point that we are already paying for health care costs for undocumented children. A report published in the American Journal of Public Health shows that uninsured immigrant children have per capita cost expenditures that were 86% lower than that of uninsured American-born children, but that expenditures for emergency room visits were three times greater.

It's also worth noting that the parents of most of these children are having social security and federal income taxes withheld from their paychecks yet little or none of that money is being sent back to the states to help with these health care costs.  This SCHIP reform is a great step forward but still does not fully address the needs of all children in America. Hopefully Congress will step up and fully fund SCHIP, returning the surplus federal taxes paid by undocumented immigrants to  help states and localities and consider truly covering all children, including undocumented kids.


First Focus poll on SCHIP
Iowa editorial on insuring ALL kids 
Progressive States Network - Provide health care for Immigrant Communities
Rhode Island H5412
NILC - State Funded SCHIP Programs