U.S. Residents Divided on Children’s Health Insurance, Survey Finds

Fifty-two percent of U.S. residents trust Democrats to handle issues with the State Children's Health Insurance Program, but the same percentage "agree with the president that government aid should be targeted to low-income families," according to a USA Today/Gallup Poll, USA Today reports.

The poll surveyed 1,009 adults from Friday to Sunday, about half of whom were questioned about children's health care.

The poll found that 52% of people agree that SCHIP beneficiaries should be children in families with annual incomes up to 200% of the federal poverty level, while 40% say SCHIP should be extended to children in families with annual incomes up to 300% of the poverty level. In addition, 55% of respondents said they are very or somewhat concerned that SCHIP would create an incentive for families to drop private coverage.

According to USA Today, the poll shows that "while Bush may be losing the political battle with Democrats, he may be doing better on policy."

HHS Secretary Mike Leavitt said that policy is most important, adding, "There's a lot of politics going on right now," but "the politics will last a matter of weeks" and "policy here will go on for decades. We have to get this right."

However, Rep. Rahm Emanuel (D-Ill.) said that other polls have indicated much greater support for the Democratic position. Robert Laszewski, an independent health policy consultant, said the results of the USA Today/Gallup Poll are not surprising, adding that unless U.S. residents are made aware of health coverage costs, "the notion that the government should be paying health insurance for the middle class is nuts."

Former CMS Administrator Mark McClellan said, "For most Americans, there's a recognition that people at moderate income levels are struggling to afford health insurance. They're just not sure that having the government pay almost all of the cost is the way to solve the problem" (Wolf, USA Today, 10/16).

Separately, Leavitt on Monday said, "There are two questions here. One is a question of ideology, who should be covered, and the second is what's the number it takes to do that. One is policy. The other is arithmetic. We need to solve the policy question, and then we can work the arithmetic out" (Johnson, CongressDaily, 10/16).

As Bush and Congress continue the debate on SCHIP, states are preparing to cap enrollment or cut children from the program because of the uncertainty of future funding levels, the Washington Post reports (Lee, Washington Post, 10/16).

Bush earlier this month vetoed legislation that would have provided an additional $35 billion in funding for the program over the next five years and increased total SCHIP spending to $60 billion. The additional funding would have been paid for by a 61-cent-per-pack increase in the tobacco tax. An override vote in the House is scheduled for Thursday (California Healthline, 10/15).

SCHIP until mid-November operates under a continuing resolution intended to maintain existing enrollment until a compromise can be reached. However, "many state program leaders say the short-term fix will not be enough to maintain existing enrollment if gridlock continues," according to the Post (Washington Post, 10/16).

Joy Wilson, a health care specialist with the National Conference of State Legislatures, said that the "immediate issue out there is the uncertainty" that states are "confronted with, just not knowing how this is going to play out," adding, "If the money (finally settled on) is a lot less (than Congress' bill), it'll put some states in the position of having to drop some covered children."

In addition, some worry that the SCHIP debate will continue and "eventually lead to a simple continuing resolution for this year that would surely engender a setback in the number of covered enrollees," according to CongressDaily. "It's unclear whether that number (in a resolution) would provide states with enough to avoid having to cut people from the program," Wilson said (Hess, CongressDaily, 10/16).

Leavitt said HHS has been working with governors of 49 states to ensure that no state would have to cut children from the program (Washington Post, 10/16).

Republicans are confident they will be able to sustain Bush's veto in Thursday's override vote, the AP/Houston Chronicle reports (Espo, AP/Houston Chronicle, 10/15).

The Bush administration on Monday said that after the override vote, it wants to begin negotiations with House and Senate leaders to expand SCHIP.

Spokesperson Tony Fratto said, "Once the veto is sustained and I think that becomes a reality for Congress," then "maybe we can sit down and try to find areas where we can agree and extend and reauthorize the program" (Hoskinson/Reichard, CQ HealthBeat, 10/15). Fratto noted that Bush wants to "try to find ways to reauthorize the program in a way that puts the poorest children first in line -- makes sure they're covered" (Hoeffel/Simon, Los Angeles Times, 10/16).

In a speech in Arkansas on Monday, Bush defended his veto, saying, "Not only is the eligibility requirement" in the SCHIP bill "being expanded way beyond the scope of the program," it "sounds like there's a nationalization of medicine going on here." Bush said that if the veto is sustained, "I call upon the leadership in Congress to come to the table" and "get money to those families that the program was intended to help."

Bush has asked Ed Gillespie, his chief political adviser; Leavitt; and White House economic adviser Al Hubbard to help negotiate a new SCHIP bill (Runningen/Nichols, Bloomberg/Boston Globe, 10/16). After the SCHIP reauthorization bill is completed, leaders should begin to discuss how to insure more U.S. residents, Leavitt said (CQ HealthBeat, 10/15).

Large health care organizations over the past year "have exerted themselves to help Democrats pass" the SCHIP bill, "even though their financial interests in the program are negligible," in hopes of "generat[ing] good will among Democrats," The Hill reports.

Endorsement from the groups -- which include America's Health Insurance Plans, the Pharmaceutical Research and Manufacturers of America and the American Medical Association -- "have already provided political cover to Democrats -- and denied it to the president and the Republican Party," according to The Hill. However, health care lobbyists "have got plenty else on their plates, so what they'll do after the vote is the subject of speculation among stalwart backers of the SCHIP bill," The Hill reports (Young, The Hill, 10/16).

KPBS' "KPBS News" on Monday reported on the debate over SCHIP. The segment includes comments from:

• Rep. Brian Bilbray (R-Calif.); and
  
• Ted Lempert, president of the advocacy group Children Now (Goldberg, "KPBS News," KPBS, 10/15).