Leadership Lacking in Kids’ Insurance Debate

By Mike Hoey, Assistant Director

The ping pong match between President Bush and Congress over the children’s health insurance program may be entertaining to politicians looking for partisan advantage for the 2008 election but if the two sides fail to negotiate their differences uninsured children will be the real losers.

Since the State Children’s Health Insurance Program (S-CHIP) was first implemented in 1997, the number of uninsured children has dropped by 2.7 million. In Missouri over 60,000 children participate. Hidden behind these impersonal statistics are children who now have access to preventive health care, regular doctor visits and medical treatment for broken bones and common childhood diseases.

After failing to override the president’s October 18 veto, Congress is considering new legislation. Concessions have been made to S-CHIP critics, but many feel the bill is being rammed down their throat. The revised bill was delivered to House members on the evening of Wednesday, October 17 and voted on early the next afternoon – providing just 17 hours to review the 200 page plus text. The bill passed but without sufficient votes to override a second presidential veto.

More thorough discussion is expected in the U.S. Senate the week of October 29 through November 2, 2007. The Senate could add amendments that will make the bill more palatable to the president, who believes the program goes too far in covering too many children and therefore claims the bill lacks focus on the truly needy.

One obstacle to an agreement was removed earlier when pro-life concerns were addressed. The National Right to Life Committee (NRLC) had opposed an earlier version they feared would encourage euthanasia. But when the offending provisions were removed, NRLC dropped their objections.

The S-CHIP legislation could move in a stronger pro-life direction if the U.S. Senate agrees to an amendment promoted by the U.S. Conference of Catholic Bishops to provide S-CHIP coverage to unborn children. Such an amendment would allow states to enhance the pre-natal care offered to expectant mothers.

But the “unborn child” amendment is going nowhere if other differences are not addressed. Missouri Congressperson Todd Akin has claimed that the bill would cover non-legal resident children. But the bill already clearly prohibits their participation.

A more serious disagreement concerns S-CHIP health coverage for middle class children. False claims have been made that the legislation will cover families with incomes up to $80,000. In fact, coverage for a family of four is limited to those with annual incomes under $62,000

But this does not appease critics who believe middle income families ought to purchase private insurance. Their argument, however, ignores crucial facts. First, to participate in S-CHIP a child must have been without health insurance for six months or more. Second, the critics are not examining the kind of middle class children covered. In most cases, these children have pre-existing medical conditions that private insurers either won’t cover or will cover only at astronomical rates. S-CHIP is filling the gap left by a private market that fails to deliver affordable insurance to too many families.

With all the objections raised to including middle income children, one would suppose that they comprise most of the S-CHIP participants. But over 90% of S-CHIP children come from families with incomes below 200% of the federal poverty level. And the vast majority of the 4 million children Congress proposes to add to the program under the re-authorizing legislation would also have these lower incomes. These are the working poor, parents whose employers don’t offer health benefits or offer them at unaffordable rates.

If Congress and the president fail to re-authorize S-CHIP, it may be retained by adoption of a continuing resolution. That may protect the current S-CHIP children - that is, if the president agrees to adequately fund the program - but an historic opportunity will be lost to extend health coverage to an additional 4 million children who currently have no health insurance. In the present impasse, leadership and political courage are required, but so far those are qualities sorely lacking in the S-CHIP debate.