HEALTH REFORM: Obama Signs SCHIP Reauthorization

Just hours after receiving final approval in the House by a margin of 145 votes, legislation reauthorizing the State Children's Health Insurance Program has been signed into law by President Obama. He made clear that expanding coverage for low-income kids is the first, but by no means the last, step his administration plans to take toward his goal of making sure all Americans have health coverage.

H.R. 2 provides the program with an additional $32.8 billion, preserving coverage for about seven million low-income children currently enrolled and extending coverage to an additional four million previously uninsured kids.

During a signing ceremony in the East Room of the White House, President Obama asserted the importance of the program saying no child should be "receiving their primary care in the emergency room in the middle of the night. "

"In a decent society, there are certain obligations not subject to trade offs or negotiations," Obama said. "Health care for our children is one of them."

COVERAGE: House Gives Final Approval to SCHIP Reauthorization

By a margin of 290–135, the House gave final approval today to legislation reauthorizing the State Children's Health Insurance Program through Fiscal Year 2013. The bill now heads to the White House, where President Obama has scheduled a signing ceremony for 4:30 pm in the East room of the White House.

The final version of the H.R. 2—passed in the Senate last week by a margin of 66–32, with nine Republican Senators voting in favor of the bill—provides an additional $32.8 billion in funding, extending coverage to four million more uninsured children and bringing total enrollment in the program to 11 million. The spending is funded by a 62-cent increase on the tobacco tax.

COVERAGE: Details, Details, Details

The devil, we're told, is in the details. We would have said Prada, but if you asked where the details matter most, we think you can make a strong argument for the programs of Medicaid and SCHIP.

First, there's the combination of state and federal funding that makes budgeting Byzantine. Add an array of eligibility, enrollment, and verification requirements. The result is a labyrinth fit for a Minotaur, yet often overwhelming to the populations these programs are intended to serve.

Which is why at a Kaiser Family Foundation briefing Friday on Children's Health Coverage: What's Next, we felt a little like Anne Hathaway, post makeover, in the Devil Wears Prada, suddenly seeing the real impact of details and policies on these programs.

KFF's Julia Paradise (slides) began the day reviewing work from the foundation on the impact of health coverage on low and middle income families. Some quick facts:

HEALTH REFORM: In the Beginning...

Welcome back.

Yes we noticed that President Barack Obama mentioned health care in his inaugural address. We were pleased, but not surprised. He's made clear that health reform is a priority.

We see there's a new look at We didn't see much new on the health care agenda portion of the site—looks like it's what we heard during the campaign and transition. But it's nice that it has found a new home.

HEALTH REFORM: Free Lunches and Filled Doughnuts

Americans want health reform. They want coverage expansion and insurance reform. As long as they can keep the health plan they have now, save money, and finance it all by taxing an upper income smoker. You know, like that guy on the Monopoly board.

They also want to fill the Medicare drug benefit doughnut hole, cover kids, and provide more care to our veterans. By taxing that same rich smoker.

 OK, we're exaggerating. The Kaiser Family Foundation did its traditional poll on the health care agenda for the new president and Congress. There was definitely some good news for those hoping for comprehensive health reform this year. A solid majority of Americans (61 percent) believe that during our economic meltdown "it is more important than ever to take on health reform now."

 But the poll also highlighted serious obstacles that reformers need to keep in mind. That includes deep partisanship and a huge amount of economic anxiety,  according to analysis offered at a Kaiser forum with three of our favorite health policy experts, Kaiser CEO Drew Altman, the foundation's public opinion research director Mollyann Brodie and Harvard professor Robert Blendon, who is an expert on health reform politics and public opinion. (webcast here, transcript in a few days)

HEALTH REFORM: House Backs SCHIP Expansion

Legislation that would reauthorize SCHIP over the next 4 ½ years passed the House of Representatives by a margin of 289 to 139 votes today (Wednesday). HR 2 would provide an additional $32.3 billion in funding to the program, increasing enrollment from 6.7 million to nearly 11 million children.

The Senate Finance Committee will consider similar legislation in a hearing tomorrow at 11:15 am.

COST: Cutbacks for the Poor Coming Fast and Furious

If the headlines aren’t depressing enough for you, here’s more glum news. States are slashing health services to poor people at such rapid rates that even a federal rescue package might not be able to restore services, the LA Times reports. And the faltering economy “has all but killed trailblazing state campaigns to expand coverage for the working poor—once seen as hopeful signs for national healthcare reform.”

In Illinois nursing homes facing bankruptcy because of slow state payments may have to relocate old and frail patients.

South Carolina has cut treatment for poor women under age 40 with breast or cervical cancer, and stopped providing nutritional supplements for kidney failure patients.

In Nevada some cancer patients, are struggling to get their chemotherapy after the largest public hospital stopped outpatient cancer services. They’ve been dubbed “medical refugees.” And the list goes on to other states, across the country.

IN THE STATES: How Soon is Now?

We asked Leif Wellington Haase, director of New America's California Program, and Micah Weinberg, a research fellow in the California program, to fill us in on the latest developments on health care in California, particularly the possible cuts to funding the state’s Healthy Family Program for low income kids.

This blog has documented the flurry of activity in health reform in Washington in recent weeks. Senator Max Baucus has floated major new proposal to overhaul the delivery and funding of care and Sen. Edward Kennedy is working on a related initiative. Former Senate Majority Leader Bill Frist has urged Republicans to work with Obama to make helping the uninsured an “immediate” priority.

But will immediately be soon enough?

IN THE STATES: Chutes and Ladders, Ballot Edition

Tuesday's election brought a series of health care initiatives to state ballots. Some, like Prop 101, blocking the state of Arizona from enacting universal coverage, are still too close to call. Others, like Michigan's Prop 1 on medical marijuana, aren't our bag (we swear officer). And still others, like measures passed in Montana and Maine, remind us that health reform at the state level can sometimes seem like a game of Chutes and Ladders.

For the more than 30,000 children in Montana without health insurance, the passage of ballot initiative I-155, "The Healthy Montana Kids" plan represents a major step forward. The measure expands the eligibility for Medicaid and SCHIP to uninsured children, whose family income is below 250 percent of the federal poverty level (previously only those in Montana with incomes below 175 percent of FPL were eligible). The plan is expected to cost around $22 million annually and will cover most of the state's uninsured children.

HEALTH REFORM: Kids as the Starting Point for a New Agenda

With so much buzz about how Rahm Emanuel may become President-elect Obama's White House chief of staff, we thought it would be useful to share this glimpse of how he saw the priorities of the new administration. It comes from a New York Magazine piece that ran shortly before the election:

"My view is that we gotta be the party of reform," Emanuel begins when I reach him on his cell phone. "There are four reforms. There's financial-regulatory reform, tax reform, health-care reform, and energy. Regulatory will kinda come down the chute fast. Tax reform will take a little longer, because it's not until 2010 that Bush's tax cuts expire. Energy, you can do some things immediately. And with health care, you've got the children's health insurance as the first piece of a series of things you gotta do."

Emanuel's reform agenda is helpful because it's clarifying-in terms of timing, in terms of priorities, and in terms of suggesting where Obama's plans and the appetites (and political tolerances) of congressional Democrats intersect.

So health care is in there, part of the Big Four. How quickly Obama moves ahead, whether SCHIP expansion will include any other health cost, quality or coverage elements, isn't yet clear. We at New America of course believe that we should—and can—do more than expand SCHIP, and we know that a lot of people on the Hill are already hard at work figuring out how to get there and the election results will only make them work harder. But even if the hard-charging Emanuel sees a more gradual approach, it's reassuring to know that he recognizes there are a lot of things "you gotta do."