Debating the CHIP Program

Much of the debate over CHIP involves the constantly invoked threat of government-run socialized medicine, usually made by conservative politicians whose ideology favors limited government programs and private business enterprise. But an increasingly vocal outcry in the debate has more to do with median state incomes than it does political or economic ideology.

The CHIP bill, which the Senate passed with a veto-proof majority (the House did not, and hence the veto, for now at least, stands), would provide insurance coverage to families whose household income totals three times the national poverty level. But incomes across the nation are not equal, of course, and some states are arguing that they will have to share limited resources with and subsidize higher costs in other states whose median family incomes are double or even triple their own.


Lawyer salaries in the United States are spread over a wide range, averaging between $44,500 and $146,000, and with the average American spending more than $6,000 per year on healthcare, the expansion of health coverage is viewed as a welcome move by many families across the nation. This average expenditure on healthcare is the highest in the world and twice the amount spent annually by citizens of Europe, where government-sponsored healthcare is the standard in most nations.

In its current form, the CHIP bill would enable a family of four with two children whose annual income totals $61,332 to enjoy substantial health coverage. The federal poverty threshold is currently $20,444 for a family of four with two children. The disparity regarding what would be available to (or even viable for) children across the nation becomes apparent when considering the median family incomes in Northeastern states like Maryland, Connecticut, and New Jersey (the three highest-income states) and Southern states like Arkansas, Mississippi, and Alabama, where the median income is almost half of that of those states at the opposite end of the spectrum.

Maryland, the state with the highest median income, allows families with incomes triple the poverty level to participate in the program; South Dakota, which is at the lower end of the family-income scale, only allows those who make double or less than double the poverty rate to enroll. There is no federal standard, and the current bill allows states to decide individually which families will be eligible and which ones will not.

States have been slow to respond to the national need for affordable family healthcare. Illinois is currently the only state in the nation to offer affordable healthcare to all children in the state aged 18 and under. The Illinois All Kids Program provides coverage for doctor's visits, hospital stays, prescription drugs, vision care, dental care, and medical devices (e.g., eyeglasses and asthma inhalers). The program's standard of eligibility states that "a family of four that earns between $40,000 and $59,999 a year pays a $40 monthly premium per child and a $10 co-pay per physician visit."

The issue is further complicated by the fact that healthcare costs vary significantly from state to state. A doctor's visit or hospital stay will cost significantly more in New York's Staten Island than it will in Cheyenne, Wyoming, for example. Lawmakers are arguing that the standards for family income should be dealt with on an individual basis; opponents are further troubled by the idea that the bill will raise the cigarette tax from $0.39 per pack to $1 per pack, a 156% increase.

Democratic Representative Gene Taylor, one of only eight Democrats to vote against the bill, said, "I do have a lot of folks in my district who are not wealthy, and I regret to say a lot of them are smokers...This is a tax on the least of us."

House Democratic Caucus Chairman Rahm Emanuel countered with the argument that Congress must provide national coverage to the middle class because "the fastest growth of the uninsured has happened among the middle class."