The Columbia Journal Review had an excellent analysis of one of the many topics in health reform that is not getting widespread coverage. The US House bill eliminates the State Children’s Health Insurance Program (S-CHIP) in 2013 and moves the children covered in this program to the new “health insurance exchanges” which will be the main way families will get coverage if reform passes the Congress. The Senate bill keeps the program until 2019 but only funds it through 2013:

It turns out that the House indeed wants to repeal the program and require kids to get coverage via the insurance exchange, the government’s soon-to-be gigantic brokerage service. Their parents, of course, would be getting subsidies to help buy coverage, courtesy of the U.S. taxpayer. Rep. John Dingell, a Democrat no less, touted the advantages of dumping SCHIP. One advantage: the program wouldn’t be subject to the periodic and occasionally problematic Congressional reauthorizations that threaten its existence. Dingell said kids could have the same insurance as their parents—an incentive to force parents to cover their kids. (Sometimes parents, daunted by bureaucratic red tape, don’t enroll their children even if they are eligible.)

Another reason for killing SCHIP, some believe, is to force kids into the new exchange’s risk pool. Kids are usually healthy; bringing them into the pool may help spread the risk and keep premiums somewhat lower for the sick people whom insurers would have to cover.

It is an open question whether children currently in SCHIP will be better off in the exchange or not. President Obama finally signed an expansion of SCHIP in January, after President Bush vetoed it twice in 2007. However, even with the expansion, the program leaves out about half of the kids who have no health insurance.

On the other hand, if the House provision were to take effect, kids might lose some valuable and comprehensive benefits now available to kids on Medicaid and SCHIP. If parents, strapped for cash, had to shop in the exchange, they might choose low-cost insurance with skimpy benefits and pay more out-of-pocket than SCHIP currently requires them to pay. SCHIP rules limit a family’s out-of-pocket costs to five percent of their income.

Senator Bob Casey from Pennsylvania proposed an amendment to guarantee full funding for SCHIP through 2019 and would also give the states generous federal funding to eliminate barriers that now prevent families from enrolling their kids, and would preserve the program’s full package of medical and mental health services. Click here to tell your Senators to support the Casey kids amendment.