March 24, 2010 8:30 AM
- Text
On Covering The Kids' Health
(The New Republic)
This column was written by Jonathan Cohn.
Of all the reasons President Bush and his conservative allies have given for opposing an expansion of government-financed health insurance for children, the one that sounds most persuasive is that a lot of these kids — or, more precisely, their families — don't need the help.
The argument goes like this: It's fine to have the government help really poor children, who couldn't get health insurance without taxpayer assistance. But under the proposals now on the table, health benefits provided by the State Children's Health Insurance Program (S-CHIP) could be available to some children in families with incomes of up to four times the poverty line — or a little more than $80,000 a year for a family of four. And that, say the conservatives, is simply too much.
"This bill essentially extends a welfare benefit to middle-class households," the administration announced last month, after an S-CHIP expansion bill passed the Senate. Over at National Review's The Corner, David Freddosso put the issue a little less delicately. "Come on, people! We're talking about whether the government should pay for your two kids' health insurance plans when you make more than $51,000 a year (more than the new national median income). I know that health insurance is not cheap, but neither are your mortgage and car insurance. You're not going to ask the government to pay for those, too, are you?"
Quotes like this make it sound like S-CHIP would become as much a middle-class accessory as minivans and cappuccinos. Not so. Many states already offer S-CHIP insurance to families with higher incomes, thanks to special waivers they received from the federal government. Yet the vast majority of children in S-CHIP, more than 90 percent, are still from families that make less than twice the poverty line, or around $41,000 for a family of four.
And it would remain that way under either the Senate S-CHIP bill or its counterpart in the House. Both bills would dedicate significant new sums of money to the program, $35 billion over five years in the Senate version and $47 billion in the House. And both would allow states to expand eligibility to families with incomes over twice the poverty line. But in both cases, it's assumed that most of the money will be spent on enrolling truly low-income children — for the most part, kids who are already eligible for S-CHIP (or Medicaid, the other federal health insurance program servicing the poor) but haven't yet signed up. This isn't coincidence: Some of the most important provisions in the two pieces of legislation are those calling for better recruitment and outreach.
Still, the proposed S-CHIP expansions would likely bring in some new children from wealthier families. (And possibly adults, too, but that's a topic for another time.) That's what has the right so angry — and ready for a fight. President Bush has already indicated he will veto anything that looks like the House or Senate bills. And, just last month, his administration issued a dictum to states, warning them that it will no longer grant permission to expand eligibility except in narrow circumstances.
But there are all sorts of reasons why a middle-class family looking for health insurance might have a genuine need for government assistance. If you can't get health benefits through your employer — and, in case you hadn't heard, employer-sponsored insurance has been in a pretty steady decline for two decades now — you have to buy it on your own. Yet if you look for non-group coverage, as it's known, you'll quickly find it's a lot more expensive than the group kind, because of higher administrative costs. And if you do buy coverage, you'll likely find it less reliable and convenient. The non-group market is notoriously unstable, with small-time carriers constantly jumping in and out, plus it's famously prone to fraud. And, of course, it's in the non-group market where insurers try hardest — and have the most ability — to avoid enrolling people that pose serious medical risks. Simply put, if you have even a moderate pre-existing condition, chances are good you won't find affordable coverage — if, indeed, you can find coverage at all.
Another reason why some middle class Americans might need assistance getting health insurance becomes apparent when you consider exactly which states are most interested in enrolling these people. Right now, the state with the highest income eligibility for S-CHIP is New Jersey. There, children in families making up to 350 percent of the poverty line can enroll. New York has recently said it would like to make insurance available to even wealthier families — those at up to four times the poverty level. Other states interested in raising levels include California and Connecticut.
Notice a pattern here? These are the states with very high costs of living and very expensive health insurance. It might seem crazy that somebody making $80,000 a year would need help getting health insurance — until you consider that the cost of living in New York is crazy, too. As The New York Times noted in an editorial this past weekend, "Health officials in New York calculate that families in New York City or on Long Island, where two-thirds of the state's uninsured children live, would need incomes above 300 percent of the poverty level just to pay for life's other necessities, like housing, food, transportation, child care and taxes, leaving no money for health insurance."
Of all the reasons President Bush and his conservative allies have given for opposing an expansion of government-financed health insurance for children, the one that sounds most persuasive is that a lot of these kids — or, more precisely, their families — don't need the help.
The argument goes like this: It's fine to have the government help really poor children, who couldn't get health insurance without taxpayer assistance. But under the proposals now on the table, health benefits provided by the State Children's Health Insurance Program (S-CHIP) could be available to some children in families with incomes of up to four times the poverty line — or a little more than $80,000 a year for a family of four. And that, say the conservatives, is simply too much.
"This bill essentially extends a welfare benefit to middle-class households," the administration announced last month, after an S-CHIP expansion bill passed the Senate. Over at National Review's The Corner, David Freddosso put the issue a little less delicately. "Come on, people! We're talking about whether the government should pay for your two kids' health insurance plans when you make more than $51,000 a year (more than the new national median income). I know that health insurance is not cheap, but neither are your mortgage and car insurance. You're not going to ask the government to pay for those, too, are you?"
Quotes like this make it sound like S-CHIP would become as much a middle-class accessory as minivans and cappuccinos. Not so. Many states already offer S-CHIP insurance to families with higher incomes, thanks to special waivers they received from the federal government. Yet the vast majority of children in S-CHIP, more than 90 percent, are still from families that make less than twice the poverty line, or around $41,000 for a family of four.
And it would remain that way under either the Senate S-CHIP bill or its counterpart in the House. Both bills would dedicate significant new sums of money to the program, $35 billion over five years in the Senate version and $47 billion in the House. And both would allow states to expand eligibility to families with incomes over twice the poverty line. But in both cases, it's assumed that most of the money will be spent on enrolling truly low-income children — for the most part, kids who are already eligible for S-CHIP (or Medicaid, the other federal health insurance program servicing the poor) but haven't yet signed up. This isn't coincidence: Some of the most important provisions in the two pieces of legislation are those calling for better recruitment and outreach.
Still, the proposed S-CHIP expansions would likely bring in some new children from wealthier families. (And possibly adults, too, but that's a topic for another time.) That's what has the right so angry — and ready for a fight. President Bush has already indicated he will veto anything that looks like the House or Senate bills. And, just last month, his administration issued a dictum to states, warning them that it will no longer grant permission to expand eligibility except in narrow circumstances.
But there are all sorts of reasons why a middle-class family looking for health insurance might have a genuine need for government assistance. If you can't get health benefits through your employer — and, in case you hadn't heard, employer-sponsored insurance has been in a pretty steady decline for two decades now — you have to buy it on your own. Yet if you look for non-group coverage, as it's known, you'll quickly find it's a lot more expensive than the group kind, because of higher administrative costs. And if you do buy coverage, you'll likely find it less reliable and convenient. The non-group market is notoriously unstable, with small-time carriers constantly jumping in and out, plus it's famously prone to fraud. And, of course, it's in the non-group market where insurers try hardest — and have the most ability — to avoid enrolling people that pose serious medical risks. Simply put, if you have even a moderate pre-existing condition, chances are good you won't find affordable coverage — if, indeed, you can find coverage at all.
Another reason why some middle class Americans might need assistance getting health insurance becomes apparent when you consider exactly which states are most interested in enrolling these people. Right now, the state with the highest income eligibility for S-CHIP is New Jersey. There, children in families making up to 350 percent of the poverty line can enroll. New York has recently said it would like to make insurance available to even wealthier families — those at up to four times the poverty level. Other states interested in raising levels include California and Connecticut.
Notice a pattern here? These are the states with very high costs of living and very expensive health insurance. It might seem crazy that somebody making $80,000 a year would need help getting health insurance — until you consider that the cost of living in New York is crazy, too. As The New York Times noted in an editorial this past weekend, "Health officials in New York calculate that families in New York City or on Long Island, where two-thirds of the state's uninsured children live, would need incomes above 300 percent of the poverty level just to pay for life's other necessities, like housing, food, transportation, child care and taxes, leaving no money for health insurance."
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