State Children's Health Insurance Program (S-CHIP)

The State Children's Health Insurance Program, or S-chip as it is known, was created in 1997 to reduce the number of uninsured children by providing subsidized insurance to children of the working poor. In January 2009, Congress voted to expand the program after nearly two years of battling with former President George W. Bush on the subject.

There is little dispute among experts that the program has been instrumental in reducing the rate of uninsurance among low-income children by almost a third, even as the rate for adults has climbed. About 16 percent of children from families with incomes below 200 percent of the federal poverty level were without insurance in 2005, down from 23 percent in 1997, according to a federal government analysis.

But even so, the number of uninsured children overall remains large -- an estimated eight million. Some of those are children in lower-income families that were the program's original target: Despite a decade of marketing efforts by governments and private foundations, nearly 30 percent of children who are eligible for the health insurance program and are not covered by private plans have yet to enroll, according to a new government study. Others are members of more middle-class families who nevertheless have not obtained coverage, in many cases, experts say, because of the skyrocketing costs of individual policies. Health care advocates have also argued in recent years that the best way to pick up uncovered low-income children is to cast a wider net, enrolling some middle-class children as well.

The program has been widely popular and has broad bipartisan support, but a battle began brewing early in 2007 as the Democrats newly in control of Congress made plans to expand S-chip far beyond the additional $5 billion over five years President Bush had proposed in his budget.

The bill was approved by Congress with unusual bipartisan support, as many Republicans also voted to expand the program from its enrollment of about 6.6 million children to more than 10 million. The measure would have provided $60 billion over five years. President Bush vetoed the bill on Oct. 3, 2007.

President Bush vetoed a second, similar children’s health bill in December 2007.

In September 2008, Congressional Democrats scrapped plans for another vote on the expansion of S-chip, after concluding that President Bush would not sign their legislation and that they could not override his likely veto.

On Jan. 15, 2009, the House voted in favor on an S-schip bill that went beyond the legislation twice vetoed by President Bush.

The new bill included a major provision allowing states to restore health insurance benefits to legal immigrants under 21, a goal of Hispanic groups since those benefits were terminated in 1996.

The Congressional Budget Office said the bill would enable states to cover more than four million uninsured children by 2013, while continuing coverage for seven million youngsters. The bill would increase tobacco taxes to offset the increase in spending, estimated at more than $32 billion over four and a half years.

In the Senate, the measures faced opposition from Republicans, including Senator John McCain, who worried that it was a first step toward a government-run health care system. Others criticized elements that would allow coverage of some children from higher-income families. But the bill passed by a 66 to 32 margin, with nine Republicans joining the Democrats.