by Phyllis Vine, editor

Buried in the footnotes of the debate over the States Children's Health Insurance Program (SCHIP) is mental health.

For the past decade SCHIP provided access and treatment where major needs exist.

According to the American Academy of Child and Adolescent Psychiatry, roughly two million school-aged children will show signs of ADHD. One adolescent in 12 will develop major depression; of them, one in 14 will attempt to end his or her life. Suicide is the third leading cause of death for people 15-24, the fourth leading cause of death for those 10-14. It is estimated that between five and 10 million adolescent girls have eating disorders. And for boys, the peak onset for schizophrenia is 18, for girls, 15.

SCHIP authorized mental health services for just these kids.

A recent poll conducted by Georgetown University indicates that 90 percent of those surveyed want Congress to expand coverage for more children. So how is it possible, in an environment thick with theories about early intervention and a host of well-publicized prevention programs, to object to helping poor kids who need medical care?

Objections come from the usual quarters with familiar clichés about holding the line on government spending, or not breaking the back of a special interest -- in this case the tobacco farmer -- or the dangers of a government takeover of health services. But no hard data.

House and Senate passed bills must be reconciled and the current decade old authorization expires on September 30th. The House version (HR3162), which passed 224-205, carries a price tag of $47.4 billion. Funding depends on raising taxes on cigarette taxes, and also trimming bloated federal payments to an insurance program run by for-profits, Medicare Advantage.

The Senate passed a veto-proof version (HR976), 68-31with bipartisan support. It rests on a steeper 61-cent-per-pack hike in cigarette taxes, but also rings in with a lower price tag of $35 billion.

Opponents of SCHIP stand in the shadows of special interests. Sen. Jim Bunning (R-KY) argues that tobacco growers, who will take a hit if consumption falls as taxes rise, should not be penalized. Rep Baron Hill (D-IN) also expressed concern that funding not fall on the backs of "our local tobacco farmers." How protecting the tobacco industry got into the same sentence as protecting kids' health has to be one of the mysteries of government.

Then there is the insurance industry with inefficiencies and overheads greater than the public programs it seeks to replace.

The irony is that the insurance industry has failed miserably to serve children. Their historic profits depend on denying or curtailing services in all areas, particularly for mental health needs. Thus it is hard to imagine what Sen. Bob Bennett (R-UT) has in mind when he claims his state’s 45,000 children would be "better directed to private plans."

Behind much of the criticism are fears that expanding SCHIP will lead to further changes in the health care system.

Folks who worry that expanding SCHIP might federalize health care should examine how 50 different states have built programs unique to them. A complete list is available from the National Conference of State Legislatures.

The remarkable thing is how diverse and tailored they are. North Dakota and New York included treatments for substance abuse; Colorado removed treatment limits for neurobiologically based mental illnesses; Connecticut and Montana allowed converting inpatient treatment to more outpatient visits; Virginia included day treatment, crisis intervention, and mental health case management; Maine and Minnesota geared their mental health benefits to the Medicaid schedule.

The variety belies any argument that health care is standardized. Whether it should be is another question, but SCHIP has certainly not produced it.

Denying health care to millions of children is morally repugnant. And most Americans know this.