Who's Really for Kids and Who's Really Just Kidding?
Jim Shmerling, DHA, FACHE, President and CEO of Children's Hospital Colorado
“Who’s for Kids and Who is just Kidding” is a popular refrain heard from Children’s Hospitals around the country during a presidential campaign. Advocates for children’s health attempt to differentiate politicians who kiss babies and espouse family values during campaigns but whose actions are contradictory to their words. Such is the case with President Bush’s recent veto of the State Children’s Health Insurance Program (SCHIP) bill and failure of the House to override it. This joint federal and state program, first enacted in 1997 with bipartisan support, is a critical source of health insurance coverage for more than six million children. Its ten-year authorization expired in September of this year, and while it has a temporary extension, members from both sides of the aisle in Congress have been working to renew it. While the president claims he supports the State Children’s Health Insurance Program, he has vetoed a bipartisan SCHIP bill championed by both Republican and Democratic leaders in Congress. Unfortunately, during the debate on this bill and resulting veto, there have been many confusing and misrepresented “facts” bandied about. Let’s set several of them straight.
There is significant scientific evidence that the general health of our children is enhanced greatly when they have access to health care, and that basic insurance coverage is the key to that access. The SCHIP program is not intended solely for the poor as that is the role of the Medicaid program. Rather it was created to fill the gap for children who are not eligible for Medicaid but whose families cannot afford private coverage. The Bush administration claims the compromise bill would cover children in families of four with incomes up to $82,600. The truth is only two states, New York and New Jersey , would be allowed to offer coverage to families earning up to 400 percent of the federal poverty level. All other states would be capped at 300 percent of the federal poverty level. Interestingly, Colorado ’s program is presently capped at an even lower level. This program is available to Colorado families under 200 percent of federal poverty level, which is less than an annual income of $41,300 for a family of four.
Additionally, the administration says the bill represents the first step toward government-run, “socialized” medicine, and that the bill would encourage families to move their children from private insurance to SCHIP or, in other words, “crowd-out private insurance.” The fact is nearly 80 percent of all children covered by the program are enrolled in commercial managed care and fee-for-service plans, and the Congressional Budget Office says the ‘crowd-out’ factor is as low as it could possibly get. Interestingly, even the health insurance lobby supports the bill.
One other unique feature of the SCHIP bill that is not often mentioned in the media but is worthy of mentioning here was a provision proposed by Senators Evan Bayh (D-IN), Orrin Hatch (R-UT), Blance Lincoln (D-AR) and our very own Ken Salazar (D-CO) called the “Children’s Health Care Quality Act” (S.1226). Today children are too small a share of the health care marketplace to stimulate private sector investment needed to develop evidence-based measures to determine how to assess and improve children’s health care. The federal government’s commitment to quality measurement and improvement has been funded for the Medicare population, a commitment that excludes our children. This legislation provides the Secretary of Health and Human Services with the authority and resources to invest in meaningful development, testing and consensus review of pediatric measures and the demonstration of models of transformation of children’s health care.
Finally, the administration claims the bill would expand government spending for children’s health care. However, the current proposed price tag is only a quarter of the cost of the president’s proposal four years ago to expand government financed health care for the elderly to include prescription drug coverage. In addition, the president’s proposed funding expansion of $5 billion for SCHIP does not come close to covering the medical inflation that has occurred since the original SCHIP appropriation during the last 10 years. Finally, the president’s proposal would result in nearly 1.4 million children currently enrolled to lose their coverage by 2012.
Closer to home, Colorado covers more than 50,000 children and 1,300 pregnant women through SCHIP. The vetoed bill would have increased Colorado 's SCHIP funding by 8 percent, or $13 million, allowing us to cover the more than 56,000 children who are eligible but who are not enrolled in the program. Without reauthorization of the SCHIP program and increased funding, Colorado 's SCHIP program will start running a deficit by 2011 – jeopardizing even the kids who are currently enrolled. The Colorado Health Foundation’s recently released “Health Report Card” gave our state a C- to our care for infants and children, citing areas such as inadequate child nutrition and immunizations. Maintaining and expanding SCHIP to levels proposed by bipartisan senate and house leadership would be one component of helping to improve our child healthcare performance here in Colorado .
On October 18, the House of Representatives failed to garner the votes needed to override the President’s veto. Throughout the coming weeks, there will be an attempt to reconcile the Administration’s position with the consensus of Congress and the majority of Americans who supported expanded insurance coverage for children. We will soon find out who is truly for kids, and who is just kidding.