The Balanced Budget Act of 1997 established the State Children's Health Insurance Program (CHIP) under a new Title XXI of the Social Security Act. CHIP builds on Medicaid by providing health care coverage to low-income, uninsured children in families with incomes above applicable Medicaid income standards. The latest official numbers show that CHIP enrolment reached a total of nearly 7.4 million children and nearly 335,000 adults in FY2008. In FY2008, federal CHIP spending totalled $7.0 billion, with states' projected spending expected to equal $7.9 billion in FY2009. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)was first passed in the House on January 14, 2009, and an amended version was passed in the Senate on January 29, 2009. This book examines the history and background the CHIPRA with a focus on the provisions included in the law.

The Children's Health Insurance Program Reauthorization Act of 2009 (H.R. 2, CHIPRA) was first passed in the House on January 14, 2009, and an amended version was passed in the Senate on January 29, 2009. On February 4, 2009, the House passed H.R. 2 as amended by the Senate and later that day President Obama signed the bill into law as P.L. 111-3. One of the provisions of CHIPRA permits using CHIP as the program's acronym, instead of SCHIP. This report reflects this change, using CHIP instead of SCHIP. The overall structure of CHIPRA is similar to its two predecessors, H.R. 976 and H.R. 3963 from the 110th Congress. This report summarizes changes to prior law made by CHIPRA, and provides a brief legislative history of the major State Children's Health Insurance (CHIP) reauthorization bills in the 110th and 111th Congresses. This report reflects the provisions at the time of CHIPRA's enactment. It is meant to serve as a historical reference to the complete set of provisions included in the law, as of February 4, 2009. It will not be updated to capture subsequent legislative changes, program guidance, public notices, or rulemaking. Key statutory changes affecting the CHIPRA provisions are listed in the subsection titled “The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)” and are further identified through footnotes tied to the relevant provisions. However, these changes are not reflected in provision descriptions included in the body of this report. (For a current description of program rules and state activity, see CRS Report R43627, State Children's Health Insurance Program: An Overview.)

This report summarizes changes to current law across the major provisions of H.R. 2 that would occur if The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) were enacted.

The Children’s Health Insurance Program was crafted in a period of intense partisan and ideological controversy over health care entitlements to provide "creditable coverage" for American children below 200 percent of the Federal Poverty Level. This objective was widely supported, though achieved only by a compromise between the structural alternatives of a block grant, similar to the Maternal and Child Health Block Grant or an entitlement resembling Medicaid. According to David G. Smith, the CHIP compromise has been a successful experiment that far exceeded expectations, both in identifying and enrolling "targeted low-income children" and in earning political capital. He argues that beyond this core mission, the reauthorization of CHIPRA (Children’s Health Insurance Program Reauthorization Act of 2009) invites a larger mission: going beyond enrollment of children to include assuring access, improving quality, and containing costs of health care for them. Extending this thrust, the author notes that CHIP could be used to establish children’s health as a niche—much like care for the elderly—within the larger scheme of health care insurance for all. Several areas of successful performance needed for the program to be adjudged a success as well as its limitations are discussed in the book. These areas include initial implementation, enrolling kids, federal-state relations, and the uses and misuses of waivers to modify the program. A description of changes made by the CHIPRA reauthorization and the new Patient Protection Affordable Care Act (PPACA) is also included. This is followed by a consideration of lessons learned from CHIP’s evolution and recommendations for future development. In short, this is a valuable and readable account for those interested in the current and future trends of health care for the young.

The Children's Health Insurance Program was crafted in a period of intense partisan and ideological controversy over health care entitlements to provide -creditable coverage- for American children below 200 percent of the Federal Poverty Level. This objective was widely supported, though achieved only by a compromise between the structural alternatives of a block grant, similar to the Maternal and Child Health Block Grant or an entitlement resembling Medicaid. According to David G. Smith, the CHIP compromise has been a successful experiment that far exceeded expectations, both in identifying and enrolling -targeted low-income children- and in earning political capital. He argues that beyond this core mission, the reauthorization of CHIPRA (Children's Health Insurance Program Reauthorization Act of 2009) invites a larger mission: going beyond enrollment of children to include assuring access, improving quality, and containing costs of health care for them. Extending this thrust, the author notes that CHIP could be used to establish children's health as a niche--much like care for the elderly--within the larger scheme of health care insurance for all. Several areas of successful performance needed for the program to be adjudged a success as well as its limitations are discussed in the book. These areas include initial implementation, enrolling kids, federal-state relations, and the uses and misuses of waivers to modify the program. A description of changes made by the CHIPRA reauthorization and the new Patient Protection Affordable Care Act (PPACA) is also included. This is followed by a consideration of lessons learned from CHIP's evolution and recommendations for future development. In short, this is a valuable and readable account for those interested in the current and future trends of health care for the young.

Children's health has clearly improved over the past several decades. Significant and positive gains have been made in lowering rates of infant mortality and morbidity from infectious diseases and accidental causes, improved access to health care, and reduction in the effects of environmental contaminants such as lead. Yet major questions still remain about how to assess the status of children's health, what factors should be monitored, and the appropriate measurement tools that should be used. Children's Health, the Nation's Wealth: Assessing and Improving Child Health provides a detailed examination of the information about children's health that is needed to help policy makers and program providers at the federal, state, and local levels. In order to improve children's health-and, thus, the health of future generations-it is critical to have data that can be used to assess both current conditions and possible future threats to children's health. This compelling book describes what is known about the health of children and what is needed to expand the knowledge. By strategically improving the health of children, we ensure healthier future generations to come.