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BMJ. 2007 October 6; 335(7622): 685.
PMCID: PMC2001097

Future of US children's health insurance still uncertain

The US State Children's Health Insurance Program, subject of a fight between President George Bush and Congress, was extended to 16 November.

The programme was to expire on 30 September, the end of the government's fiscal year and the end of the programme, which began 10 years ago and needs renewal every five years.

Congress passed a “continuing resolution” to extend it and several other programmes.

The current programme, funded partly by the federal government (about 70%) and partly by the states (about 30%), covers more than six million children. The proposed expansion would cover another four million.

Last month Congress voted to renew and expand the programme to cover more children in families with incomes too high to qualify for Medicaid insurance but too low for them to afford private health insurance. The Congressional plan would cost an additional $35bn (£17bn; €25bn) over the next five years. Proposing a more modest expansion, Mr Bush said that he would veto the bill as it stood, but he had not done so as the BMJ went to press.

He said it was a step towards socialised medicine and would cause children to be taken out of private health insurance to be covered under the federal state programme (BMJ 2007;335:637 doi: 10.1136/bmj.39349.400069.DB and 2007;335:62-3 doi: 10.1136/bmj.39269.413530.DB)

A presidential veto can be over-ridden by a two thirds vote in both houses of Congress. A combination of Democrats and Republicans who support the Bill have enough votes to over-ride a veto in the Senate, but they are about 24 votes short in the House.

The fight for children's health insurance became emotional in the media last week. The BBC described Deamonte Driver, who died from a tooth infection that spread to his brain. His mother couldn't find a dentist who would accept Medicaid payment and couldn't afford to pay for the extraction herself (http://news.bbc.co.uk, 28 Sep, “Boy's death highlights US health debate”).

After Mr Bush gave his weekly radio address, the Democrats had 12 year old Graeme Frost of Baltimore, Maryland, give the rebuttal. Mr Frost said, “If it weren't for [the programme] I wouldn't be here today,” the Baltimore Sun reported (www.baltimoresun.com, 29 Sep, “Boy to give radio address”). He said he had been admitted to hospital in a coma for a week after the family car skidded on ice and crashed in 2004. His mother, employed by a medical publishing firm, and his father, a woodworker, had a combined family income of $45 000. Neither had health insurance through their work and they couldn't afford it because it would cost about $1200 a month, more than their mortgage. But their children were eligible for the children's health insurance programme.

The American Medical Association and AARP (formerly the American Association of Retired Persons, with 39 million members), supported expanding the programme, to be funded by an increase in the cigarette tax. The American Cancer Society ran an advertisement of a young child and a cigarette and the headline, “Mr President, choose wisely.”

However, the Associated Press news agency reported complaints that the cigarette tax increase would hit the poor and minorities, who smoke more than richer Americans (www.nytimes.com, 30 September “Poor smokers would pay for health bill”).


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