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The State Children's Health Insurance Program (SCHIP) – now known more simply as the Children's Health Insurance Program (CHIP)〔(【引用サイトリンク】 title=Children's Health Insurance Program )〕 – is a program administered by the United States Department of Health and Human Services that provides matching funds to states for health insurance to families with children.〔Sultz, H., & Young, K. Health Care USA Understanding its Organization and Delivery pg. 257〕 The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid. At its creation in 1997, CHIP was the largest expansion of taxpayer-funded health insurance coverage for children in the U.S. since Lyndon Johnson established Medicaid in 1965. The statutory authority for CHIP is under title XXI of the Social Security Act. It was sponsored by Senator Edward Kennedy in a partnership with Senator Orrin Hatch with support coming from First Lady Hillary Rodham Clinton during the Clinton administration.〔〔〔 States are given flexibility in designing their CHIP eligibility requirements and policies within broad federal guidelines. Some states have received authority through waivers of statutory provisions to use CHIP funds to cover the parents of children receiving benefits from both CHIP and Medicaid, pregnant women, and other adults. CHIP covered 7.6 million children during federal fiscal year 2010, and every state has an approved plan.〔(【引用サイトリンク】title=FY 2010 Number of Children Ever Enrolled in Medicaid and CHIP )〕 Despite CHIP, the number of uninsured children continued to rise, particularly among families that cannot qualify for CHIP. An October 2007 study by the Vimo Research Group found that 68.7 percent of newly uninsured children were in families whose incomes were 200 percent of the federal poverty level or higher as more employers dropped dependents or dropped coverage altogether due to annual premiums nearly doubling between 2000 and 2006. Vimo cites the Kaiser Commission on Medicaid and the Uninsured when it says 48 percent of the newly uninsured were not eligible for any kind of public coverage, and that only those in the lowest income bracket might offset the loss of employer-sponsored coverage with increases in Medicaid and SCHIP.〔 Obtain a (copy from the Internet Archive ).〕 In FY 2008, the program faced funding shortfalls in several states. Two attempts to expand funding for the program were vetoed by President George W. Bush, who argued that such efforts were steps toward federalization of health care, and would "steer the program away from its core purpose of providing insurance for poor children and toward covering children from middle-class families." On February 4, 2009, President Barack Obama signed the ''Children's Health Insurance Reauthorization Act of 2009'', expanding the healthcare program to an additional 4 million children and pregnant women, including undocumented immigrants without a waiting period. ==History== As a part of the fallout from the failed 1993 Clinton health care plan, both Democratic Senator Ted Kennedy and the Clinton administration were looking for smaller initiatives for publicly funded health care that could gain bipartisan support. Kennedy was intrigued by a children's health insurance plan in Massachusetts that had passed in 1996, and met with a Boston Medical Center pediatrics director and a Massachusetts state legislator to discuss the feasibility of a national initiative. Kennedy also saw using an increase in tobacco taxes as a way to pay for the expanded coverage.〔 Thus, in October 1996, Kennedy introduced a bill to provide health care coverage for children of the working poor, to be financed via a 75 cents a pack cigarette tax increase. Meanwhile, in December 1996 First Lady Hillary Rodham Clinton examined several possible initiatives and decided expanding health care insurance to children who had none was the one to advance.〔 The focus on children was politically popular.〔 Additionally, Hillary Clinton had discussed an SCHIP-ish program with a White House health policy coordinator while advocating for a full-scale health care reform initiative. A variant of the program, dubbed "Kids First", had been envisioned during the original 1993 Task Force on National Health Care Reform meetings. The new initiative was proposed at Bill Clinton's January 1997 State of the Union address, with the stated goal of coverage up to five million children.〔〔 Kennedy continued to write much of the bill, using the increase in tobacco taxes to pay the $20 billion price tag.〔 In March 1997, Kennedy brought Republican Senator Orrin Hatch onto the legislation as co-sponsor; Kennedy and Hatch had worked together as an "odd couple" in the Senate before, and here Hatch said that "Children are being terribly hurt and perhaps scarred for the rest of their lives" and that "as a nation, as a society, we have a moral responsibility" to provide coverage.〔 Hatch's role would infuriate some Republican colleagues〔 and conservative commentators. The First Lady did not hold news conferences or testify before Congress on behalf of the bill.〔 An initial objection of Republicans in the Senate was that proposing to pay for the services by raising the federal tax on cigarettes, from 24 cents a pack to 67 cents a pack, ignored the likely consequence that sale of tobacco products would decrease and tax revenues would increasingly fall short of those needed to pay for the expansion of benefits. Kennedy and Hatch scoffed at the objection, with the former saying, "If we can keep people healthy and stop them from dying, I think most Americans would say 'Amen; isn't that a great result?' If fewer people smoke, states will save far more in lower health costs than they will lose in revenues from the cigarette tax."〔 Republicans also criticized the bill as an open-ended entitlement program, although it was structured as a block grant rather than an entitlement;〔 Senate Majority Leader Trent Lott was an early opponent of the measure, calling it a "big-government program" that would not pass. Then the bill had to comply with the existing balanced budget agreement between Congress and the White House, something that Lott said it did not.〔 Pressure was on to reduce the amount of grants involved, with $16 billion a possible compromise; Hillary Clinton instead argued for $24 billion.〔〔 The Clinton administration had a deal with the Republican leadership in Congress that forbade the administration from backing any amendments to the budget resolution.〔 Thus, Bill Clinton phoned members of Congress and asked that they kill the children's health insurance provision when it came to the floor.〔 On May 22, it was so done, with the necessary cigarette tax amendment defeated by a 55–45 margin. Hillary Clinton defended her husband's action at the time, saying "He had to safeguard the overall budget proposal,"〔 but Kennedy was surprised and angered by it,〔 considering it a betrayal,〔 and saying that his calls to Bill Clinton and Vice President Al Gore had not been returned.〔 Hatch was also upset, saying that Lott may have been bluffing and that, "I think the President and the people in the White House caved here."〔 Kennedy did not give up on the measure, saying: "We shall offer it again and again until we prevail. It's more important to protect children than to protect the tobacco industry."〔 Both Bill and Hillary Clinton argued for including the children's health insurance in subsequent legislation.〔 The bill was indeed revived by Kennedy and Hatch a month after its initial defeat.〔 Organizations from the Children's Defense Fund to the Girl Scouts of the USA lobbied for its passage, putting public pressure on Congress;〔 Hillary Clinton was pushing for it as well,〔 with Kennedy urging her to use her influence within the White House.〔 SCHIP was then passed and signed into law by Bill Clinton on August 5, 1997〔 as part of the Balanced Budget Act of 1997, to take effect the following month. At a press conference following the signing, Kennedy thanked Hatch, Senate Minority Leader Tom Daschle, Children's Defense Fund head Marian Wright Edelman, Bill Clinton, and Hillary Clinton.〔 About the latter, Kennedy said, "Mrs. Clinton ... was of invaluable help, both in the fashioning and the shaping of the program and also as a clear advocate."〔 SCHIP is located at Title IV, subtitle J of H.R. 2015 () Balanced Budget Act of 1997. H.R. 2015 was introduced and sponsored by Rep John Kasich () with no cosponsors.〔[http://www.govtrack.us/congress/bill.xpd?bill=h105-2015 H.R. 2015 [105th]: Balanced Budget Act of 1997 (GovTrack.us)]〕 On 25 June 1997, H.R. 2015 passed House Vote Roll #241 mainly among partisan lines, 270 ayes and 162 nays, with most Democrats in the House of Representatives in opposition. On the same day, the bill passed in the Senate, with a substitute amendment, by unanimous consent. After a conference between the House and Senate, passage in both House (Roll #345: 346-85) and Senate (Roll #209: 85-15) on the conference substitute became more bipartisan. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「State Children's Health Insurance Program」の詳細全文を読む スポンサード リンク
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