Gambling with CHIP (Pork, Perks and Politics, not Poker)

We've been hearing and reading about how desperately Congress needs to pass the bill to fund - and expand - SCHIP, the Children's Health Insurance Program. However, you may not have heard about the pork, perks and politics that are included in the current versions of the House and Senate bills, which led President Bush to threaten to use his veto.

When Congress returns from their August break, the House and Senate versions will be the subject of conference committees charged with ironing out the differences, in order to send a bill to the President by the deadline of September 30.

(For the amounts currently spent on Medicaid and SCHIP, see total Medicaid funding and total SCHIP funding for fiscal year 2006.)

This week's American Medical Association News (available free for 90 days) pleads for expansion:

In terms of patient access, the stakes can't be overestimated. In an AMA poll of nearly 9,000 physicians, 60% said next year's 10% cut would force them to limit the number of new Medicare patients they treat or stop seeing beneficiaries altogether. Doctors simply cannot absorb a financial hit of that magnitude.

The House bill would preserve seniors' and disabled patients' access to doctors by replacing the next two years of physician pay cuts with 0.5% increases each year. The measure is not without problems, however. The AMA is working to remove Medicare provisions dealing with physician-owned hospitals and imaging services.

As for SCHIP, a congressional failure to reauthorize the program would devastate children's health care access. About 6 million children (and about 600,000 adults) rely on this program.

Reauthorizing SCHIP at $25 billion -- its level for the past five years -- is not an option. That amount would not be enough to cover the children who are currently enrolled, let alone the roughly 2 million uninsured kids who are eligible for the program, but not enrolled.

Fortunately, the House and Senate bills would increase funding by $50 billion and $35 billion over five years, respectively. This would provide enough money to extend coverage to all eligible, uninsured children.

The House measure would not change states' existing family income limits. About half of the states cover children from families up to 200% of poverty, and the other half cover kids from families above that limit. The most generous level, in New Jersey, is 350% of poverty. The Senate legislation would allow states to cover children in families earning up to 300% of the federal poverty level.

Some Republicans, including President Bush, have said the SCHIP expansions envisioned in the House and Senate bills go too far. Bush's budget proposed a $5 billion increase in funding over five years and an eligibility limit of 200% of the federal poverty level. On Aug. 17, the Bush administration issued new standards that make it more difficult for states to cover children from families above the 250% mark. Republican critics argue that the House and Senate measures are a step away from private coverage toward nationalized health care.

But this argument ignores the statistic that 70% of children on SCHIP are enrolled in private health plans that contract with the states. The remainder are in public plans operated by the counties or in fee-for-service SCHIP.

With about 9 million U.S. children lacking insurance, Congress should make sure the funding level it settles on is enough to enroll uninsured children who are eligible for SCHIP.

Congress already has found two sensible ways to pay for Medicare payment relief and the SCHIP expansion. To help prevent the Medicare physician payment cut, the House bill would end overpayments to private health plans operating in the program. It is only fair that Medicare Advantage be on equal footing with the program's traditional component.

The House and Senate measures would pay for the children's insurance expansion by increasing the federal tobacco tax (currently 39 cents) by 45 cents and 61 cents, respectively.

However, there are other opinions about the cuts to Medicare in order to fund the SCHIP expansion, the hidden pork that favors some hospitals over others, and the language and focus change from covering prenatal care to covering a wide range of "reproductive health services" for women who are pregnant, rather than covering prenatal care and delivery of their unborn children.


"Don't pit children against seniors" Washington Post Letter to the Editor describes the effects of cutting Medicare programs in order to increase funds for SCHIP.

"Select Hospitals Reap a Windfall Under Child Bill," a New York Times piece on the custom of building in increased reimbursement for certain hospitals, without actually naming those hospitals or noting which legislator put the perk in the Bill:

The two hospitals in Kingston, N.Y., that are beneficiaries of the bill, Benedictine Hospital and the nearby Kingston Hospital, recently announced an agreement that would bring them together under a single parent corporation.

Neither hospital is named in the bill, but they are the only ones that could qualify. The bill guarantees higher Medicare payments for New York hospitals with a “single unified governance structure,” located less than three-fourths of a mile apart in a city with a population of 20,000 to 30,000.

and

Lawmakers did not identify St. Vincent by name, but referred to a hospital with Medicare provider number 360112. That is the identification number for St. Vincent.

There's also the change in language from care for unborn children to pregnant women - which leads to fears that abortion services will be required, and changes the focus from "Child" toward universal government health care.

From the Left: "Bush and SCHIP: It’s Also About Fetuses"

And from the Right: "Protect Life: Tell the House to vote NO on H.R. 3162"