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Children Need Medical Care, Too

This column was written by the editors of The New Republic.

Say this much for our president: He is consistent. Back in the 1990s, when he was still governor of Texas, he had an opportunity to help some of his neediest constituents get affordable medical care. The federal government had just created the State Children's Health Insurance Program, or S-CHIP, making billions in new spending available to states that created public insurance programs for poor kids and their families. While even some of his fellow Republican governors were jumping at the opportunity, Bush balked. The program might get expensive in the long run, he feared. And, oh dear, it would mean more government. So Bush fought efforts to create an expansive S-CHIP program in Texas, arguing a minimalist version would be better, even though the state had one of the highest proportions of uninsured residents in the country.

The Texas legislature, though hardly a bastion of socialism, didn't see things Bush's way — and bullied him into supporting a bigger program. But now, as president, Bush is waging the same fight all over again. S-CHIP is up for reauthorization this year. With even more Americans uninsured than in the '90s, Congress seems inclined to expand it so that it can cover more people. Under a new bipartisan proposal in the Senate, S-CHIP funding would increase by $35 billion over the next five years, allowing it to reach many of the children who still lack insurance.

But Bush, backed by some of his more conservative allies, wants no part of this. He's willing to reauthorize the program, but he also wants to restrict it — by, among other things, limiting eligibility to only those people who are below 200 percent of the poverty level. Under his counterproposal, at least 17 states would actually lose S-CHIP funding, meaning that more kids and families in desperate need of medical insurance would go without.

Why the resistance? Money, for one thing. To pay for the expansions, Democrats have proposed raising taxes on cigarettes and rescinding some of the unnecessary subsidies Bush's Medicare drug plan famously throws at insurance companies — steps that are no more popular with this administration than with its supporters in the tobacco and insurance lobbies. But the fight is also philosophical. Bush and his allies object that, for every 10 people who gain insurance through S-CHIP expansions, between two and five fewer will get private insurance — since employers, particularly those with low-income workers, will be less likely to offer coverage once the public alternative is available.

But this hardly matters as long as the net effect is an expansion of insurance — which clearly is the case here, as the Congressional Budget Office recently concluded. Thanks to S-CHIP, the number of people without health insurance today is much lower than it might be otherwise; if the program expands, it will be even lower in the future. To put it in human terms, that means millions of more kids getting their regular checkups and — when they need it — more serious medical care.

Of course, what really spooks Bush and the right is the possibility that S-CHIP could be a stepping stone to universal coverage. It's a legitimate fear. If Americans notice what a good job government has done insuring kids, they might clamor to have it cover more adults, too — which, come to think of it, sounds like a pretty good idea as well.

By the editors of The New Republic
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