Children Smell Bad, Or So Says The White House

Friday, September 28th 2007
Healthcare Policy • Politics • Uninsured • Healthcare Costs • Medicare/Medicaid

The State Children’s Health Insurance Program is a joint federal/state program to insure low income children. The least offensive redistribution of wealth imaginable. Here’s a summary of it. Even I’m a a pom-pom waving supporter of the program.

Currently there’s a big fight in Washington over it. In case you somehow missed it, the decade old program was set to expire this year but today the Senate passed HR 976, thus following the lead of the House which had earlier passed the same bill. The House however didn’t pass the bill by enough to overcome President Bush’s threatened veto.

The House on Tuesday passed a bill providing health insurance to more than 10 million children, but supporters of the measure fell short of the two-thirds majority they would need to override a veto repeatedly threatened by President Bush.

Explaining his objections, Mr. Bush said, “The bill goes too far toward federalizing health care and turns a program meant to help low-income children into one that covers children in some households with incomes of up to $83,000 a year.”

And thus lies the real debate. The reauthorization of SCHIP expands the program in several ways. Notably it allows states to increase the eligibility to children of families at 300% of the federal poverty level. That’s potentially an extra 4 million uninsured children and billions of dollars over the next decade. However screwed up the federal poverty level is as a measure of true poverty, is it really appropriate to relieve a family of four, living off >$60,000 of the responsibility of providing insurance for their children?

There are other problems. Many states, notably Texas, have a long tradition of failing to enroll a good number of the currently eligible uninsured children. And we want to expand the program?

It is a legitimate debate. I’ve said it before when I was up lobbying the Texas legislature for the state level reauthorization earlier this year, and I’ll say it again…I don’t know where the level should be drawn in terms of eligibility. However even as I admit that, and in a little bit of a shocker for my usual steadfast libertarian position, I’m willing to err on the side of caution in this case and back the legislation sitting in front of Bush, rather than let the SCHIP program expire.

Kaiser Family Foundation Forum On SCHIP Reauth

However artificial my distinction I’ll continue believing in the notion that something is owed to children that isn’t to adults. Those children with poor access to care didn’t contribute in anyway to the situation they’re in. There are collective social responsibilities owed to them. Contentions to the contrary or contentions that the government isn’t the best avenue to guarantee these children access, such as those made by Congressmen like Paul Ryan, are simply mind numbingly stupid.

More government-run, big-bureaucracy health care that pushes people out of private coverage isn’t the answer to our health care crisis. We need a more comprehensive fix that will put health coverage within everyone’s reach, without bankrupting taxpayers down the road. Making the health care marketplace work to lower costs, boost competition, and improve quality - not expanding government’s reach - should be the focus of our efforts.

Who knows what boosting the eligibility would do in terms of having families at the higher threshold of eligibility dump private insurance (indeed we’ll probably never know with Bush’s veto); what is clear from studies is that to date SCHIP has experienced almost no cost shifting (families dumping private insurance to have the government pick up the tab). Why Congressman Ryan and others believe that as a risk with expanded eligibility is simply not clear. Nor is it realistic to imagine that the best way to ensure health access for these children is through the private market.

Here’s hoping, in some sort of miracle in Washington, that the SCHIP reauthorization gets through sooner rather than later.