The conflagration over the reauthorization of the State Children’s Health Insurance Program (SCHIP) offers a compelling example of Washington’s current inability to address even seemingly uncontroversial matters such as improved health care coverage for children. After the House failed to override President George W. Bush’s veto of a SCHIP expansion in October, Congressional leaders regrouped to develop a compromise measure that would address Bush’s claim that the original bill “moves the health care system in the wrong direction.”1 SCHIP permits coverage of children in families whose incomes (according to evaluation methods developed by the states) are at or below 200% of the federal poverty level. Like the first bill that Congress passed in the fall, the second measure would have provided states with the authority to extend the standard to 300% of the poverty level (with a limit of 350% permitted in New Jersey) while reducing states’ flexibility in determining what income counts in eligibility assessments. The bill also moved more aggressively to end SCHIP coverage of parents and other adults, imposed tougher citizenship-documentation requirements, and required states to try harder to avert health insurance crowd-out — the actual or potential tendency of one form of health insurance to substitute for other available coverage. (NEJM)