I 
109TH CONGRESS 
1ST SESSION H. R. 1668
To amend titles XIX and XXI of the Social Security Act to ensure that 
every uninsured child in America has health insurance coverage, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 14, 2005
Mr. WAXMAN (for himself, Mr. PALLONE, Mr. DINGELL, Mr. BROWN of Ohio, 
Mr. RANGEL, Mr. STARK, Mr. MARKEY, Mrs. CAPPS, Mr. CONYERS, Mr. 
RUSH, Mr. DOGGETT, Ms. SCHAKOWSKY, Mr. MEEK of Florida, Ms. 
MILLENDER-MCDONALD, Ms. SCHWARTZ of Pennsylvania, Mr. GENE 
GREEN of Texas, and Mr. ALLEN) introduced the following bill; which 
was referred to the Committee on Energy and Commerce, and in addition 
to the Committees on Ways and Means and Education and the Work-
force, for a period to be subsequently determined by the Speaker, in each 
case for consideration of such provisions as fall within the jurisdiction of 
the committee concerned 
A BILL 
To amend titles XIX and XXI of the Social Security Act 
to ensure that every uninsured child in America has 
health insurance coverage, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Kids First Act of 2005’’.
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows:
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
TITLE I—EXPANDED COVERAGE OF CHILDREN UNDER 
MEDICAID AND SCHIP 
Sec. 101. State option to receive 100 percent FMAP for medical assistance for 
children in poverty in exchange for expanded coverage of chil-
dren in working poor families under medicaid or SCHIP. 
Sec. 102. Elimination of cap on SCHIP funding for States that expand eligi-
bility for children. 
TITLE II—STATE OPTIONS FOR INCREMENTAL CHILD COVERAGE 
EXPANSIONS 
Sec. 201. State option to provide wrap-around SCHIP coverage to children who 
have other health coverage. 
Sec. 202. State option to enroll low-income children of State employees in 
SCHIP. 
Sec. 203. Optional coverage of legal immigrant children under medicaid and 
SCHIP. 
Sec. 204. State option for passive renewal of eligibility for children under med-
icaid and SCHIP. 
TITLE III—TAX INCENTIVES FOR HEALTH INSURANCE 
COVERAGE OF CHILDREN 
Sec. 301. Refundable credit for health insurance coverage of children. 
Sec. 302. Forfeiture of personal exemption for any child not covered by health 
insurance. 
TITLE IV—MISCELLANEOUS 
Sec. 401. Requirement for group market health insurers to offer dependent cov-
erage option for workers with children. 
Sec. 402. Effective date.
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) NEED FOR UNIVERSAL COVERAGE.—
(A) Currently, there are 9,000,000 chil-
dren under the age of 19 that are uninsured. 
One out of every 8 children are uninsured while 
1 in 5 Hispanic children and 1 in 7 African
American children are uninsured. Three-quar-
ters, approximately 6,800,000, of these children 
are eligible but not enrolled in the medicaid 
program or the State children’s health insur-
ance program (SCHIP). Long-range studies 
found that 1 in 3 children went without health 
insurance for all or part of 2002 and 2003. 
(B) Low-income children are 3 times as 
likely as children in higher income families to 
be uninsured. It is estimated that 65 percent of 
uninsured children have at least 1 parent work-
ing full time over the course of the year. 
(C) It is estimated that 50 percent of all 
legal immigrant children in families with in-
come that is less than 200 percent of the Fed-
eral poverty line are uninsured. In States with-
out programs to cover immigrant children, 57 
percent of non-citizen children are uninsured. 
(D) Children in the Southern and Western 
parts of the United States were nearly 1.7 
times more likely to be uninsured than children 
in the Northeast. In the Northeast, 9.4 percent 
of children are uninsured while in the Midwest, 
8.3 percent are uninsured. The South’s rate of
uninsured children is 14.3 percent while the 
West has an uninsured rate of 13 percent. 
(E) Children’s health care needs are ne-
glected in the United States. One-quarter of 
young children in the United States are not 
fully up to date on their basic immunizations. 
One-third of children with chronic asthma do 
not get a prescription for the necessary medica-
tions to manage the disease. 
(F) According to the Centers for Disease 
Control and Prevention, nearly 1⁄2 of all unin-
sured children have not had a well-child visit in 
the past year. One out of every 5 children has 
problems accessing needed care, and 1 out of 
every 4 children do not receive annual dental 
exams. One in 6 uninsured children had a de-
layed or unmet medical need in the past year. 
Minority children are less likely to receive prov-
en treatments such as prescription medications 
to treat chronic disease. 
(G) There are 7,600,000 young adults be-
tween the ages of 19 and 20. In the United 
States, approximately 28 percent, or 2,100,000 
individuals, of this group are uninsured.
(H) Chronic illness and disability among 
children are on the rise. Children most at risk 
for chronic illness and disability are children 
who are most likely to be poor and uninsured. 
(2) ROLE OF THE MEDICAID AND STATE CHIL-
DREN’S HEALTH INSURANCE PROGRAMS.—
(A) The medicaid program and SCHIP 
serve as a crucial health safety net for 
30,000,000 children. During the recent eco-
nomic downturn and the highest number of un-
insured individuals ever recorded in the United 
States, the medicaid program and SCHIP off-
set losses in employer-sponsored coverage. 
While the number of children living in low-in-
come families increased by 2,000,000 between 
2000 and 2003, the number of uninsured chil-
dren fell due to the medicaid program and 
SCHIP. 
(B) In 2003, 25,000,000 children were en-
rolled in the medicaid program, accounting for 
1⁄2 of all enrollees and only 19 percent of total 
program costs. 
(C) The medicaid program and SCHIP do 
more than just fill in the gaps. Gains in public 
coverage have reduced the percentage of low-in-
come uninsured by one-third from 1997 to 
2003. In addition, a recent study found that 
publicly-insured children are more likely to ob-
tain medical care, preventive care and dental 
care than similar low-income privately-insured 
children. 
(D) Publicly funded programs such as the 
medicaid program and SCHIP actually improve 
children’s health. Children who are currently in-
sured by public programs are in better health 
than they were a year ago. Expansion of cov-
erage for children and pregnant women under 
the medicaid program and SCHIP reduces 
rates of avoidable hospitalizations by 22 per-
cent. 
(E) Studies have found that children en-
rolled in public insurance programs experienced 
a 68 percent improvement in measures of 
school performance. 
(F) Despite the success of expansions in 
general under the medicaid program and 
SCHIP, due to current budget constraints, 
many States have stopped doing aggressive out-
reach and have raised premiums and cost-shar-
ing requirements on families under these pro-