This vote was on an amendment by Lisa Murkowski, R-Alaska, that would require states to develop best practices for how to address the “crowding out” effect within 12 months.  This refers to the idea that expanding the State Children’s Health Insurance Program (SCHIP) will entice lower-income people to drop their private health insurance in favor of SCHIP coverage.  The amendment was offered to a bill that expands and reauthorizes SCHIP, which offers health insurance for children of families who are too poor to purchase private health insurance, but not poor enough to qualify for Medicaid.

Murkowski said her amendment would require the collection of data.  It also would stipulate that if states want to allow families earning more than 300 percent of the federal poverty level to qualify for SCHIP, they must first show that the state is covering 80 percent of its children below 200 percent of the federal poverty level.

“My amendment is pretty straightforward. It allows the Secretary to ensure that what we have is a built-in safeguard—a safeguard measure—for at least 80 percent of the poorest of our children to be enrolled in SCHIP or a Medicaid expansion program before children from higher income families—those earning above 300 percent—are enrolled. This amendment provides flexibility to the States in working with the Secretary of Health and Human Services to ensure that we are protecting our poorest kids by insuring them before we expand to higher income populations,” Murkowski said.

Max Baucus, D-Mont., said Murkowski’s amendment would kick children off the SCHIP rolls who are already being covered, if their families earn more than 300 percent above the federal poverty level.

“States cannot be held accountable for things beyond their control.  This amendment would make States responsible for things such as the private insurance market, the percent of employers offering health coverage, and the overall economy—matters which are beyond the control of States. These factors and others contribute to the level of uninsured kids. States should be encouraged to cover as many low-income kids as possible, not penalized for doing so. This amendment draws an arbitrary line between 200 percent and 300 percent of poverty. I don’t think that makes sense,” Baucus said.

By a vote of 47-51, the amendment was rejected.  Every Republican present voted for the amendment.  All but six Democrats present voted against the amendment.  The end result is that the measure went forward without language that would have required states to ensure that they are covering 80 percent of children whose families earn below 200 percent of the poverty level before they can cover children from families earning more than 300 percent above the federal poverty level.