The Balanced Budget Act of 1997 (PL 105-33) created Title XXI of the Social Security Act, the State Children’s Health Insurance Program (CHIP), perhaps the most significant expansion of health care coverage since passage of Medicare and Medicaid in 1965. As the implementation process begins, CHIP holds great promise to serve all eligible low-income, uninsured children, an estimated 2.9 – 4.0 million.
Yet warning signs already exist. The Congressional Budget Office has projected that only 2.3 million will be served by the third year of the program and that spending will be well below the amount appropriated by Congress. A NASI-1P review of CHIP implementation plans submitted by 24 states to the Health Care Financing Administration (HCFA) projects that no more than 1 million children will be served by these states in the first year. There is also disagreement about the number of eligible low-income children nationally and in states whose populations may not be accurately represented in national samples. Do these early warning signs mean that the program will fail to achieve expectations? Do they reflect the fact that this worthwhile and valuable program addresses very complicated problems that are difficult to solve?
Early indications suggest that people interested in CHIP–Members of Congress, Governors, state legislators, state and federal policymakers, advocates, and families–need to have realistic expectations about what is possible and how soon it can be done. This paper examines what might be expected in the coming years as state and federal agencies begin the lengthy implementation process.