SCHIP Update: Our Children's Health

Almost every day, my inbox is filled with more information our our president’s failure to provide for children’s health. As you can tell by the length of this post, this issue is one I feel strongly about. Here are a few links and excerpts of the recent discussion on SCHIP, which expires on September 30.

From Families USA:
The additional funding provided by the CHIP bill would lead to a substantial reduction in the number of uninsured children. As currently approved, the Senate bill would cut the nation’s rolls of uninsured children—estimated at more than 9 million—by about 4 million, a 44 percent drop. The House version, with a higher proposed funding level, would reduce the number of uninsured children by about 5 million, or 55 percent.
To view a special report, click here and find out how many more children would be covered in your state. For example, in my state of California, the new House bill would reduce the number of uninsured children by 56%!

From Common Sense:
Last month, the Bush administration issued state government new restrictions on providing children’s health insurance via threatening emails sent on a late Friday evening.

And this past Friday, the Bushies used those restrictions to deny New York State the ability to cover more of its uninsured kids.

Sorry kids. No doctors for you.

From Campaign for America’s Future:
Bush says he is afraid that if we provide health care to more children, “. . . you’re really beginning to open up an avenue for people to switch from private insurance to the government.” And he worries that Americans will then demand health care for all of us! So he’s using his veto threat to try to get Congress to back down.

From the New York Times:
The Bush administration reached a deplorable, preordained verdict yesterday when it denied New York State permission to expand a valuable health insurance program to help cover middle-class children. The administration, which makes no effort to disguise its disdain for government insurance programs, imposed new, excessively stringent requirements last month that not only guaranteed New York’s denial but will make it nearly impossible for any state to expand coverage.

The administration’s first reason for denying New York’s request was that the state has failed to show that it has enrolled at least 95 percent of all the children below 200 percent of the poverty level before moving the eligibility bar to higher incomes. New York says it has one of the country’s highest participation levels — at 88 percent — which sounds plenty good enough to justify reaching higher. So far as we know, no state has met the 95 percent level and many experts think it is unattainable in a group that is difficult to reach and motivate.

Another ground for denial — that New York had failed to require that children above 250 percent of poverty be uninsured for a full year before enrollment — may be the most irrational of all. The administration claims that its goal is to make sure that families don’t drop existing group health coverage to enroll in S-chip. But one year is too long for any child to go without insurance with the likely result that medical needs will be ignored.

From Common Sense:
SCHIP expires Sept. 30, and Congress has not determined the program’s fate.

SCHIP provides health coverage for 225,593 Florida youngsters from low-income households who do not qualify for Medicaid. A study has shown most of the recipients are black or Hispanic, live in poverty and went without any health insurance before signing up for the program.

Supporters fear if Congress doesn’t agree to continue the funding, tens of thousands of poor children in Florida alone and millions more across the country will go without regular medical care or flood already busy emergency rooms, driving up health care costs for everyone. Critics argue the tax-funded program has stretched beyond its original aim and is vulnerable to abuse.

From Common Sense:
Remember when conservatives wanted to “devolve” power away from Washington towards the states?

When the State Children’s Health Insurance Program was enacted in 1997, empowering states was part of the plan, giving states flexibility in determining eligibility for coverage.

But now that states are acting compassionately and broadening eligibility so all kids can actually be covered, conservatives no longer want to empower the states. They want to lecture and limit the states.

From Common Sense:
The latest Census report on poverty in America found the number of Americans without health insurance continues to rise.

A record 47 million uninsured in 2006, including 8.7 million kids. That’s 15.8% of Americans, up from 15.3% in 2005. The increase in uninsured children is more pronounced: 11.7% of kids lack coverage, up from 10.9% the prior year.

Since the passage of the State Children’s Health Insurance Program in 1997 through 2004, the program succeeded in reducing the percentage of uninsured kids, while the percentage of uninsured adults — not served by any new public insurance plan — has gone up.

But in the last two years, we’re seeing more kids go without insurance. Why?

Fewer private-sector employers are providing sufficient coverage. Making the expansion of SCHIP even more critical if we are to keep our kids healthy.

“Despite SCHIP’s earlier success in decreasing the number of uninsured children, their numbers have risen for the second straight year because of a decline in employer-based coverage,” Stoll said in a statement. “Today census numbers only confirm what state officials and health care advocates have seen first-hand — SCHIP resources must be increased to meet the health care needs of the increasing number of uninsured children.”

From the New York Times:
The program is popular because it works. It’s cost effective and there is wide bipartisan support for its expansion. But President Bush, locked in an ideological straitjacket, is adamant in his opposition.

In addition to the new rules drastically curtailing the ability of governors to expand local coverage by obtaining waivers from the federal government, the president has threatened a veto of Congressional efforts to fund a more robust version of the overall program.

“It’s stunning,” said New York’s Gov. Eliot Spitzer. “He says he’s going to veto health care for kids because it’s too expensive at the same time that these continuing resolutions for the war, where we don’t even know what the cost is, are going through unabated. This is insanity.

From the New York Times:
But a child who doesn’t receive adequate health care, like a child who doesn’t receive an adequate education, doe

sn’t have the same shot — he or she doesn’t have the same chances in life as children who get both these things.

And insurance is crucial to receiving adequate health care. President Bush may think that lacking insurance is no problem — “I mean, people have access to health care in America. After all, you just go to an emergency room” — but the reality is that the nine million children in America who don’t have health insurance often have unmet medical or dental needs, don’t have a regular place for medical care, and frequently have to delay care because of cost.

We offer free education, and don’t worry about middle-class families getting benefits they don’t need, because that’s the only way to ensure that every child gets an education — and giving every child a fair chance is the American way. And we should guarantee health care to every child, for the same reason.

From US Representative Stark:
“During George Bush’s presidency, the number of people without health insurance has already increased by more than eight million,” said Stark. “The number of uninsured increased by more than two million in this year alone, including 700,000 children. Now Bush wants to deny health care to millions more children. He would like to underfund the successful Children’s Health Insurance Program (CHIP), limit states’ ability to use program funds they do receive, and veto Congressional legislation that would extend CHIP to provide care to an additional five million uninsured children.”

From the New York Times:
The Bush administration has imposed new requirements on a valuable children’s health insurance program that look so draconian as to be unattainable. Late on a recent Friday while Congress was in recess, a time fit for hiding dark deeds, the administration sent a letter to state health officials spelling out new hurdles they would have to clear before they could insure children from middle-income families unable to find affordable health coverage. Some 19 states may be forced to pull back programs they have started or proposed.

Yet the Bush administration wants to return to a darker age. Its letter to state officials seems intent on virtually eliminating such coverage for middle-income children, or at least drastically reducing it.

Take a new requirement that states must show they have enrolled 95 percent of the children in families with incomes below 200 percent of the poverty level before they can extend the limit above 250 percent . It is surely appropriate that states do a good job of reaching the poorest children before they embark on anything beyond that. Yet the 95 percent goal seems virtually unattainable in an income group that is notoriously hard to reach, as the administration should know from its abysmal results in trying to enroll the low-income elderly in its Medicare drug benefit. No state has reached 95 percent, so all may ultimately be disqualified.

Another difficult hurdle calls for states that want to insure children from higher-income families to show that, over the past five years, there has been no more than a 2 percent decline in employer coverage of such children. The ostensible goal is to make sure that S-chip does not substitute for coverage provided by employers. But employers have been reducing health benefits for some time, mostly for reasons having little to do with S-chip. Depending on how the murky calculation is made, New York could be rejected on that ground alone.

Other requirements, though attainable, seem just plain wrong-headed. In families with incomes above 250 percent of the poverty level, children must be uninsured for a full year before they can be enrolled in S-chip. There can be no exceptions, even if a parent dies and the child loses coverage under an employer’s group policy. New York proposes a far more reasonable six-month wait, long enough to deter people from abandoning their employer’s coverage, and would waive that for people who lose their jobs or coverage involuntarily. One year is just too long to leave children uninsured.

The heated political debate over S-chip sometimes leaves the impression that it is a free handout to middle-income Americans. But it is not free: states typically charge premiums that rise as income rises, and there can be deductibles and co-payments beyond that. New York calculates that its proposed premium of $60 per month per child for the higher-income families is essentially comparable to what it costs to insure a child under employer-provided policies in the state.

From Common Sense:
The Robert Wood Johnson Foundation released a new SCHIP poll today, finding that 63% of voters (including 53% of self-described “conservatives”) support “expanding SCHIP to cover an additional 4 million uninsured children at an additional cost of $35 billion over five years.”

Further, 64% (including 50% of conservatives) disapprove of President Bush’s pledge to veto the bills pending in Congress.

From OpenKY:
The President’s SCHIP scheme, and all the heated rhetoric from House and Senate Republicans, is a blindingly hypocritical exercise in political pageantry. The Republican proposals don’t merely destroy the flexibility that has been essential to the program’s success; they destroy the flexibility that the administration has been praising for more than six years.

From its first year, the Bush administration aggressively expanded, without reservation, the waiver system that allowed states to customize their SCHIP programs to local needs. The administration regularly touted the system’s flexibility as the key to its efficiency and a model for other federal health programs. Now the Republicans are attacking SCHIP for that same flexibility.

From the New York Times:
Despite a decade of marketing efforts by governments and private foundations, nearly 30 percent of children who are eligible for the health insurance program and are not covered by private plans have yet to enroll, according to a new government study.

Late last week, the Bush administration published new standards intended to prevent states from expanding eligibility for the program to cover children from middle-class families. But a more fundamental debate over the program has been raging in Washington for months: how to find and enroll the 1.7 million low-income children who are already eligible but have not signed up.

That hard-to-reach population is the focus of a showdown over reauthorizing the 10-year-old program, the largest single extension of government-subsidized health insurance since the Great Society health initiatives of 1965.

The challenge of enrolling those already eligible demonstrates how difficult it will be for states to meet the new standards. The policy says that states can expand eligibility only if they have first enrolled 95 percent of those who now qualify. Few states have come close to doing that; the national enrollment rate in 2004-2005 was 72 percent, according to the study.

From Children’s Health Campaign:
The Senate to vote and renew the Children’s Health Insurance Program (CHIP) by a veto-proof vote of 68 to 31.

Over two-thirds of the Senate shrugged off repeated Presidential threats and demonstrated that the health of America’s children is not a Republican or Democratic issue, but a bipartisan issue that unites the American

From the New York Times:
o problem — “After all, you just go to an emergency room” — and, with the support of the Republican Congressional leadership, he’s declared that he’ll veto any Schip expansion on “philosophical” grounds.

So what kind of philosophy says that it’s O.K. to subsidize insurance companies, but not to provide health care to children?

Well, here’s what Mr. Bush said after explaining that emergency rooms provide all the health care you need: “They’re going to increase the number of folks eligible through Schip; some want to lower the age for Medicare. And then all of a sudden, you begin to see a — I wouldn’t call it a plot, just a strategy — to get more people to be a part of a federalization of health care.”

Now, why should Mr. Bush fear that insuring uninsured children would lead to a further “federalization” of health care, even though nothing like that is actually in either the Senate plan or the House plan? It’s not because he thinks the plans wouldn’t work. It’s because he’s afraid that they would. That is, he fears that voters, having seen how the government can help children, would ask why it can’t do the same for adults.


  1. Vijay Goel, M.D. says:

    The debate isn’t as easy as just covering kids with insurance– there is a real issue in terms of kids that get dropped from private insurance rolls: namely that SCHIP reimbursement is lower and takes income away from already struggling general pediatricians.

    I’m hesitant to push for more SCHIP coverage without more pediatric reimbursement– they are already amongst the lowest paid physicians out there and this may paradoxically make it harder for kids to get care, as pediatricians either specialize or stop accepting SCHIP patients.

    I have a bit more in my blog


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