White House Under Fire for Restricting Kids’ Health Coverage
Congressional leaders on Tuesday said that they will attempt to override new standards for enrollment in the State Children's Health Insurance Program that aim to limit coverage to the lowest-income children -- the "latest volley in the national battle over the future" of the program, the Boston Globe reports (Dembner, Boston Globe, 8/22).
Under the new standards, states must demonstrate that they have "enrolled at least 95% of children in the state below 200% of the federal poverty level" who are eligible for Medicaid or SCHIP before expanding eligibility to children in families with incomes greater than 250% of the poverty level, according to a letter sent Friday to state officials by Dennis Smith, director of the Center for Medicaid and State Operations.
States seeking to expand SCHIP eligibility also "must establish a minimum of a one-year period of uninsurance for individuals" in families with incomes greater than 250% of the poverty level to prevent them from switching from a private insurance plan to a public program, the letter states. Smith wrote that states should impose copayments and premiums that are similar to the cost of private health insurance on middle-income families to prevent them from dropping private coverage to enroll in SCHIP.
States that insure children in families with annual incomes greater than 250% of the poverty level also must prove that "the number of children in the target population insured through private employers has not decreased by more than two percentage points over the prior five-year period," according to the letter. In addition, states will need to adopt policies "preventing employers from changing dependent-coverage policies that would favor a shift to public coverage," Smith wrote (California Healthline, 8/21).
Sen. Maria Cantwell (D-Wash.) in a statement said, "The president knows that Congress has enough votes from both parties to overcome the veto he threatened over" the SCHIP bills, "so now he's trying something else," adding, "I hope he will stop and put aside political grandstanding so that more than 10 million American children can have a healthier future" (Aleccia, Spokane Spokesman-Review, 8/22).
Rep. Pete Stark (D-Calif.) said that none of the states "are going to get 95% of people signed into these programs," adding that administration officials "have set a hurdle that's impossible. They might as well just come out and say, 'let's kick kids off the rolls'" (McClatchy/Hartford Courant, 8/22).
Stark continued, "I can't try and guess what kind of mindset would foster this." Stark added that the proposal "cuts down the ability of the states to provide medical care to children" (Bloomberg/Winston-Salem Journal, 8/22).
Smith said the new guidelines are "aggressive, but doable" (McClatchy/Hartford Courant, 8/22). According to Smith, "SCHIP was created for children in low-income families. We want to make sure those kids are covered before we go to the higher-income kids" (Boston Globe, 8/22).
White House spokesperson Tony Fratto on Tuesday said that the new guidelines would prevent SCHIP from becoming "essentially a middle-class entitlement," adding, "As states have expanded into higher income levels, we actually are seeing SCHIP become a substitute for private insurance."
Fratto said, "States are looking to vastly expand eligibility for SCHIP at a time when no states are making adequate progress in enrolling the target populations, which are families with children at, or below, 200% of the poverty line" (Bloomberg/Winston-Salem Journal, 8/22).
In related news, the Times on Tuesday examined how efforts to find and enroll uninsured children that are eligible for SCHIP is a "fundamental debate" that "has been raging in Washington for months" as lawmakers work on legislation to reauthorize and expand the program.
States have increased efforts to enroll children through outreach; eliminating waiting periods; simplifying the application process and income verification methods; and providing translators to immigrants.
However, the challenges of finding eligible children "demonstrates how difficult it will be for states to meet the new standards" announced by the Bush administration on Friday, according to the Times.
Janice Cardin -- the supervisor in Guilford County, N.C., for Health Choice, the state's version of SCHIP -- said, "We've beat the bushes every which way but loose to find these kids," but "we know there are still a lot of them out there" (Sack, New York Times, 8/22).
House SCHIP reauthorization legislation (HR 3162), is a "critically misguided" effort that "severely cuts medical benefits for seniors," Rep. Tim Murphy (R-Pa.) writes in a Pittsburgh Post-Gazette opinion piece.
According to Murphy, the bill "creates loopholes allowing people to qualify for coverage for which the SCHIP program was never intended," including individuals up to age 21 "who are certainly no longer children." In addition, the House version could allow undocumented immigrants and families with annual incomes greater than $100,000 to qualify for the program, Murphy writes.
"It is not fair to cut benefits for fixed-income seniors so that people who can afford health care can receive a government subsidy," Murphy says.
He concludes, "Congress must focus on real health care reform," adding, "Reducing medication errors, eliminating infections and other patient safety measures would save hundreds of billions of dollars each year, enough to fund SCHIP without having seniors lose their benefits" (Murphy, Pittsburgh Post-Gazette, 8/22).