| Summary: | Since 1965 and the passage of Medicaid, federalism has been at the heart of U.S. health care policy making. After the 1994 failure of the Clinton plan to enact national health insurance reform, Congress in 1997 passed the State Children's Health Insurance Program, which has been hailed as "one of the hallmarks of devolution" and the most significant initiative in national health policy in over three decades. Ten years after its implementation and after two vetoes by George W. Bush of attempts to expand the program, this paper presents an overview of the program and intergovernmental relations, with a special focus on New York and Texas. It seeks to show that although S-CHIP is popular and has increased coverage for low-income children, the nationwide disparities which are characteristic of American federalism and social programs remain. These disparities cast doubt on the ability of the federal-state partnership in its current form to achieve incremental health care reform. Beyond the issue of children's insurance, the controversy over the program's reauthorization in 2007 has showcased the ideological battles over the role of the federal government in the provision of health care that are bound to be a major issue for the next presidency.
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