This vote was on an amendment by John Ensign, R-Nev., that would prohibit states from using State Children’s Health Insurance (SCHIP) funds to cover non-pregnant adults unless the state had enrolled at least 95 percent of low-income children. 

The amendment was offered to a bill that would reauthorize SCHIP and expand the program’s funding by about $35 billion over the life of the bill.  To offset the cost of expansion, the bill would increase the federal tax on cigarettes by 61 cents, to $1 per pack.  The SCHIP program – funded primarily through taxes on tobacco products -- helps low income families with children afford health insurance, and currently covers about 6 million kids. 

The program is intended to be a health insurance safety net for poor children, but states have been given significant flexibility to design their own benefit packages, within certain guidelines.  Some states use SCHIP funds to provide health coverage to very poor adults as well as children, or to cover children from families whose incomes are more robust than SCHIP would otherwise allow.  Republicans are strongly opposed to this practice, and worry that it represents one step closer toward establishing another large new health-care entitlement program along the lines of Medicaid.

Echoing many of those concerns, Ensign said his amendment would not take SCHIP money away from states, but would require states to prioritize children before adults.

“We have heard a lot about the need to cover low-income kids, about keeping them healthy, and giving them a chance in life. If the States aren’t forced to cover 95 percent of the low-income kids first, they will continue the current policies and many low-income kids won’t be reached out to and brought into the SCHIP program. If we require the States to cover 95 percent of low-income kids, we will be amazed at how many of these kids the States will find,” Ensign said.

Max Baucus, D-Mont., said Ensign’s amendment is unrealistic and would mean states would immediately have to cut off all adults who depend on SCHIP for their health insurance.

“There is no State in the Nation that could meet 95 percent. We have mandatory driver’s license requirements in States, and even those mandatory requirements average, nationwide, about 85 percent,” Baucus said. “So no State can possibly reach 95 percent compliance, which would mean, at the beginning of the date of enactment, all adults would be off—right now, immediately; all parents off—right now, immediately. And I don’t think that is what we want to do. Why? Because the administration has granted lots of waivers to a lot of States for a lot of adults, and States are reliant on them.”

By a vote of 43-55, the Senate defeated Ensign’s amendment.  All but four Democrats present voted against the amendment (Byron Dorgan and Kent Conrad of North Dakota, Ben Nelson of Nebraska and Bill Nelson of Florida).  Of Republicans present, 39 voted against the amendment and 10 voted for it.   The end result is that the measure went forward without language that would have prohibited states from using SCHIP funds for non-pregnant adults until it had enrolled at least 95 percent of low-income children.