SCHIP: Just the Beginning


Last week, President Bush vetoed a proposal that would extend the State Children's Health Insurance Program (SCHIP). SCHIP, instituted in 1997, is a program designed to reduce the number of uninsured children by providing subsidized insurance to children of the working poor.

A little background: Jointly financed by the federal and state governments, SCHIP is administered by the states, which determine the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures. The program benefits became available on October 1, 1997 and consisted of $24 billion dollars in matching federal funds over a period of 10 years. Medicaid covers approximately 28 million uninsured children. SCHIP aims to extend coverage to 5 million "targeted low-income" children who are ineligible for Medicaid, typically from families with income up to 200 percent of the federal poverty level. In 2007, this comes to about $41,000 for a family of four.

There is broad consensus that the program has helped reduce the rate of uninsurance among low income children by almost a third (perhaps such a program could benefit adults, whose rate of uninsurance has steadily climbed). Despite this, the number of uninsured children is relatively staggering– an estimated 9 million (up 600,000 from 2005 to 2006). Some of those are children that were the intended "targets" for SCHIP. It's been a decade and about 30 percent of eligible children have yet to enroll, according to a new government study. For an excellent primer on the specifics of SCHIP and the debate see this issue brief from the Kaiser Commission on Medicaid and the Uninsured.

Now for the politics:Read More… Early this year, emboldened by their gains in Congress the Democrats began an effort to expand the program, based on its successes and keeping in mind its previous bipartisan support. If SCHIP funding levels remain the same, many states run the risk of losing coverage for many uninsured children. In July, the Senate voted to allocate $35 billion over the next 5 years; the House later voted, by a far narrower margin, to increase the program by $50 billion. With funding set to expire on Sept. 30, in mid-September the House and Senate agreed on a compromise bill including the Senate's proposed spending increase, which officials estimated would allow the coverage of about four million additional children. This is the bill that President Bush has just vetoed.

With the House vote at 265-149, the supporters of the bill will likely be unable to override Bush's veto, scheduled for October 18, 2007. In anticipation of the veto, Democratic leaders folded an extension of the S-CHIP program at its current funding level until mid-November into a stopgap budget measure recently passed.

What are the reasons given by President Bush, for vetoing the expansion of a successful program? On Wednesday in Lancaster, PA he said,

"I believe in private medicine. I believe in helping poor people, which was the intent of SCHIP, now being expanded beyond its initial intent. I also believe that the federal government should make it easier for people to afford private insurance. I don't want the federal government making decisions for doctors and customers."

This, of course, is not what SCHIP does. Under it, children are covered by private insurance, and have choices as to which private company they use. "Typically, children have a choice from among competing private health-insurance companies," Stan Dorn, a senior research associate with the Urban Institute, a non-partisan, DC-based research group, said in an NPR interview. "There's no federally specified benefits package. There's no individual entitlement," says Dorn.

There are also other myths, spoken as fact by President Bush, reported on by Julie Rovner of NPR.

Strangely, what is missing in all this coverage of SCHIP is the awareness children's poverty does not occur in a vacuum. We hear nothing about the rest of their families, poor and likely uninsured themselves. Family income and parent's employment status are perhaps the most important determinants of whether children have health care coverage and of the specific type of coverage they have. Children in mother-headed families are less likely to have insurance. As are children whose parents' jobs do not provide adequate coverage for their dependants.

What we have here is not a simple plan to insure poor children; it is a commentary on the state of this nation's working poor, many of whom are women. Poor pregnant women face these discrepancies before their children are born. Low-income women are consistently subject to poor or non-existent pre- and neo-natal care. If the Republicans truly cared about the welfare of pregnant women and the healthy children they hope to have, they would be at the forefront of such legislation.

There are so many people in the US who, despite earning well above the federal poverty level are unable to provide health care for their families and young children. Nonetheless, last week we heard the president complain that SCHIP would cover children who don't need government help. "This program expands coverage, federal coverage, up to families earning $83,000 a year. That doesn't sound poor to me," Bush said in Lancaster. Despite the fact that this is not true (the bill actually places limitations on income level eligibility), it demonstrates the administration's cavalier attitude toward the fact that many families who earn well above poverty levels are also unable to cover their children.

This debate on SCHIP seems to be a harbinger for the bigger debate about national health policy that has already become a staple issue in the presidential campaigns. It is being reported as a debate between two competing visions of universal coverage: federal or privatized. Allowing this framing of the debate is concession to party-politics. Republicans speak the words "socialized healthcare" with such loathing that you'd think it was the plague itself. Democrats are bending over backwards to make sure we don't think that they're actually advocating socialized healthcare. Yet the system of private coverage is disastrous and has left almost 50 million Americans in the lurch. Perhaps we'd gain more ground if we pushed our legislators outside the useless parameters of this bipartisan debate and into a conversation about how to solve the problem that when many people in our country get sick, they aren't able to get better.

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