Short Circuiting S-CHIP

The Nation: White House, Lobbyists Team Up Against Child Health Insurance Program

(The Nation)  This column was written byTrudy Lieberman.

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If ever there was a motherhood-and-apple-pie issue, reauthorizing the popular State Children's Health Insurance Program (S-CHIP) is it. Yet the Bush administration, right-wing think tanks and health insurance companies have managed to turn a no-brainer into a pitched battle over the direction of healthcare reform, jeopardizing the future of S-CHIP itself. The fight over S-CHIP, which must be renewed by September 30, reflects deep divisions in Washington and shows the difficulties of making improvements in the healthcare system.

By every measure, the ten-year-old program - passed during the Clinton administration as a bipartisan, incremental effort to expand health coverage to millions of poor kids - has been a success. Thanks to S-CHIP, the number of low-income uninsured kids dropped by one-third over the decade, even as the number of uninsured adults went up. Three out of four eligible kids participate, and studies show they receive preventive care and have improved health outcomes and school performance. "It has been the only success story in initiatives to improve healthcare access," says Cindy Mann, who directs Georgetown University's Center for Children and Families.

S-CHIP enjoys broad support among Democratic and Republican governors. Its flexibility allows states to tailor their own programs or build on existing Medicaid arrangements to target children typically in families with incomes of up to 200 percent of the federal poverty level (about $41,300 for a family of four this year). Last year 91 percent of kids on S-CHIP lived in families with incomes at or below that amount. States have stepped in to fill a gap the federal government has refused to address: Nineteen states target or plan to target kids from families whose income is greater than 250 percent of the poverty rate, and some cover pregnant women and parents of eligible kids, a strategy that has proved successful in reaching more children.

What's wrong with this picture? It doesn't square with the right's ideology or the profit goals of the insurance industry, which has the upper hand in Congress. This summer the House and Senate passed bills reauthorizing S-CHIP, but by mid-September it became clear that the House bill, which added 5 million uninsured kids to the rolls and paid for their coverage partly by cutting government overpayments to Medicare Advantage plans, would lose to the more minimal Senate approach. Giving health insurance to more kids instead of overpaying highly profitable insurance companies seemed like a good trade. But the Senate, lobbied all year by the insurance industry, didn't see it that way.

The Senate bill covers only 4 million uninsured children, paying for the coverage with a 61-cent increase in the tobacco tax. It also retains the government handouts to insurance companies, which receive on average 12 percent more than it costs Medicare to provide benefits to seniors under the traditional. Influential GOP senators, targeted by sellers of Medicare Advantage plans heavily marketed in rural areas, are adamantly against cuts to Medicare Advantage. "It's very frustrating to see a phenomenal House bill and then move toward the Senate bill," says a spokesperson for the Center on Budget and Policy Priorities. Negotiators say the issue of overpayments will be taken up later this year, when Congress must consider whether to implement scheduled cuts in Medicare payments to doctors, a fight that will pit doctors against insurance companies. But the insurance lobby has won this round.

Neither the House nor the Senate bill covers all the children in need. Nearly 9 million kids now have no health insurance, and up to two-thirds of them are eligible for S-CHIP or Medicaid. Even so, for the Scrooge in the White House, both bills cover too many children. He has threatened to veto any bill, labeling the expansion a step toward "government-run healthcare." Never mind that S-CHIP kids get care from private doctors or managed-care organizations that contract with the government, just as Medicare beneficiaries do. The Senate bill puts $35 billion more into financing S-CHIP; the House bill would have added $50 billion. Bush would add only $5 billion, not even enough to maintain the 6 million kids who are currently covered.

The Administration is taking no chances. To make sure that more kids will go without health insurance, in August it short-circuited the legislative process, issuing a "guidance" that makes it almost impossible for states to expand coverage to kids in families whose incomes are above 250 percent of the poverty level unless the state can show that 95 percent of children in families under 200 percent are enrolled, a standard that's unachievable for a voluntary program (participation in Medicare Part B is about 93 percent, and enrollment is automatic). The number of uninsured children has started to climb again, as employers continue to drop coverage for their parents. Loss of employer coverage has declined for families at all income levels targeted by S-CHIP expansions.

The guidelines halt expansions already under way in states like Oklahoma and Louisiana, which had approved eligibility for kids from families whose incomes are at 300 percent of the poverty level, and in Vermont, where more than 2,000 children from families with incomes between 225 and 300 percent of poverty will lose their insurance. "It's really outrageous," says Alan Weil, executive director of the National Academy for State Health Policy. "The dirty secret is that the Administration had been approving states to do what they have now told them not to do."

Apparently the Administration prefers to unleash families into the Darwinian jungle of the private insurance market, where only the wealthiest and healthiest can buy a policy. Public programs like S-CHIP, it argues, "crowd out" insurance sold by WellPoint and United Healthcare, depriving them of profits they earn selling coverage to S-CHIP families. Meanwhile, each year medical insurance consumes a greater share of family income. The truth is that most families can't afford those policies. The price for family coverage now averages $12,000, or about 20 percent of income for a family of four with income at 300 percent of the poverty level.

Families can, of course, buy one of the new bare-bones policies, such as the one sold in Ohio by Anthem Blue Cross and Blue Shield with deductibles ranging from $4,000 to $20,000 ($8,000 to $40,000 if the family uses out-of-network providers). The policy covers only two doctor visits per year, and families must pay 30 percent of any hospital bill after satisfying the deductible. Pity the family whose child suffers recurring strep infections or needs an emergency appendectomy. Insurers also have long lists of health conditions people cannot have if they hope to get coverage. If poor kids have asthma, were born prematurely or are prone to ear infections, they're out of luck.

The realities of the health insurance marketplace have not stopped the "educational" efforts on Capitol Hill by right-wing think tanks, which have provided the ideological muscle for the assault on S-CHIP. Their rhetoric has reached the point of silliness; one recent memo on the Heritage Foundation website is titled "The House S-CHIP Bill: Enlisting States as Agents of Government Dependency." The Cato Institute held a briefing called "Sinking S-CHIP: A First Step Toward Stopping the Growth of Government Health Programs." Heritage and the American Legislative Exchange Council called their briefing "S-CHIP Expansion: Bad for Kids, Families, and Taxpayers." They are equating healthcare for poor kids with socialism. If that's the case, our children will be the first casualties on the way to marketplace perfection.

[ioweign]

Those sickly children should quit whining and pull themselves up by their Chinese made boot straps. There are seriously deprived rich people out there and they deserve another tax cut.

Posted by omega39 at 08:26 PM : Sep 24, 2007

And don''t go to Canada for that lower costing prescription either. We didn''t catch that TB patient but we have improved and we will catch those pills.

[twylacrat]

The Bushies only care about children BEFORE they are born. Apparently, after they''re born......they couldn''t care less, unless they''re born with a nice big fat trust fund.

[balto_babs]

Trouble with Dubya is that even during his days at Harvard Business School he has stated his belief that "people are poor because they%u2019re lazy."

Sounds like his mother, Barbara Bush at the Houston Astrodome while visiting the Katrina evacuees "And so many of the people in the arena here, you know, were underprivileged anyway, so this is working very well for them."

Obviously this attitude has shaped his decision on SCHIP $35 Billion (over 5 years) to provide health insurance to the children of those "lazy" poor folks versus $360 Billion to continue War in Iraq for next 5 years. Much of that money will pay for the "no-bid" contracts to corporations like Halliburton and Blackwater thus lining the pockets of his and Cheney''s cronies.

[omega39-2009]

Those sickly children should quit whining and pull themselves up by their Chinese made boot straps. There are seriously deprived rich people out there and they deserve another tax cut.

[dan9111]

This article is pretty blatantly defending violent behavior. Whether it is Bush''s program or the other one, it still missing the point. They want the program but refuse to pay for themselves. It is always a "wish for magic" while threating those who disobey. So it''s not about children -- it''s just violence.

Pull the plug. If the goal is to help children, the last people you want deciding is politicians. They will spend it all to murder Iraqis and fund sick Al Gore and Michael Moore movies. Keep dreaming guys, and these kids will suffer. Your magical "regulatory" system is the cause.

[mbcsmith]

The LIBS want to insure children of family''''s making $80,000 a year. This attempt at socialist medicine WILL fail as it should. The program was intended to insure families at or near the poverty line. The LIBS just don''''t get it. As always, just playing politics.

[tejasdemo]

Go to Hell Bush and Cheney.

[balto_babs]

Hey, CBS why did the VP''s nickname get translated into *** Cheney. Next time I''ll just have to use my personal favorite nickname for him "il Duce" instead of the common nickname for Richard.

[balto_babs]

I sure that if Bush, Congress, Insurance executives and their Lobbyists had to pay over 1/5 of their yearly salary for their medical insurance they would have a completely different attitude. Folks like *** Cheney (with a zillion pre-existing conditions) could never qualify for private medical insurance, instead the taxpayers cover his mecial bills.

It is a national disgrace that a 12 year old boy in the suburbs of Washington, DC died in Feb. 2007 because an infection from an abcessed tooth spread to his brain. Maybe his life might have been saved if the money a medical insurance lobbyist spent taking a member congress to lunch could have used for his dental care.

[ianlou]

All I hear about in the World News is all the people across the globe suffering with socialized medicine. It''s great to be an American who never has to hear about medical coverage problems in our great land! The land of "Do or Die".

[truthheals]

bush or Ahmendinejad,
bush or Ahmendinejad,
bush or Ahmendinejad...

hmmm

[mbcsmith]

The LIBS want to insure children of family''s making $80,000 a year. This attempt at socialist medicine WILL fail as it should. The program was intended to insure families at or near the poverty line. The LIBS just don''t get it. As always, just playing politics.

[knyghtwolf]

Hmmmm, chimp with a bird brain? Sounds like gene splicing to me. It seems if one would tax the oil companies along with the tobacco and pharmacutical corporatins who have profit margins beyond imagination, health care for OUR CHILDREN would not be an issue now would it? The biggest problem with having a monkey with a bird brain is that it thinks in reverse and thinks that WE, the PEOPLE work for it rather than it working for US. Instead of working our country under monkey politics, we need to go back to the basics of who works for whom and WHY.

[bombadil4]

Absurd and increasingly damaging as this administration has become on this and many other issues(such as Iraq) there is nevertheless little evidence that their tactics of instilling fear, creating diversions, attaching scary-sounding labels to the ideas of others, etc. will stop working on an increasingly dumbed-down society. Sorry, but with 1 in 3 kids not graduating high school, with our air waves and video games a wasteland of stupidity and violence, and our "news" mixed in with so_called entertainment and icreasingly under the control of corporations and government, we simply are not the informed and involved citizenry needed for anything that might resemble democracy.

[sparks224]

The Health Insurance industry has become a text book definition of Evil.

[myidoncbs]

Ever notice how Bush looks like a predatory bird in many pictures? He either looks like a chimp, or a hawk, depending on whether he''s playing "cowboy Bush" or "war president Bush". In the picture attached to the related story, "Bush Presidency", he seems to be veering into the hawkish territory.

I prefer the pictures of chimp Bush, the ones where he looks like a complete buffoon. Those pics allow me to think of him as cute, but dumb-- sort of harmless. Too bad the reality is quite different.

Pity the child that grows up in BushWorld.

[andor3]

Bush agenda: more profits for health corporations! less health care for kids! Screw Americans! Tell me more ways to give American''s money to my corporate buddies!

Gee if only America was a democracy and the people had a voice to stop this... hey, wait a minute...

[aldee41]

The next President will be a Democrat.
Chose wisely. Chose Richardson.

[johnshaft4]

Bush will turn the sick children into Soylent Green to feed his illegal "guest worker" slaves.

[soldat44]

I am actually quite of elites getting things for free, whether they be the elite of failure and want, or the elite of greed and corruption.

How about we treat all citizens equal under the law, and give free health are to some only if we give it to all.

Posted by SharnCedar at 08:22 AM : Sep 23, 2007

What?

Did you pass English Language Arts in school? No disrespect intended.