A series of Medicaid expansions passed by Congress beginning in the mid-1980’s aimed to address the problem of rising uninsured rates throughout the 1970s and early 1980s among children in families with incomes below the federal poverty level (FPL). As these expansions unfolded during the following decade, attention began to turn toward rising uninsured rates among children with family incomes between 100 and 200 percent of the FPL, due largely to declines in private insurance coverage (Cunningham and Kirby 2004). Although attempts at national health care reform failed in 1994, Congressional leaders of both political parties supported development of legislation to help children who fell into this coverage gap. The State Children’s Health Insurance Program (previously known as SCHIP, now called CHIP) passed with bipartisan support as part of the Balanced Budget Act of 1997 and became law on August 5, 1997, as Title XXI of the Social Security Act (P.L. 105-33).