Children's Health

Backers of Vetoed SCHIP Bill Say It's Misunderstood

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President Bush has made good on his promise to veto a bill to expand a popular children's health insurance program, saying the bill could lead the nation toward a system of socialized medicine.

But backers of the measure, who are working to override the veto, say the president doesn't understand how the bill would actually work.

At issue is the State Children's Health Insurance Program, known as SCHIP. It currently covers about 6 million children in families that earn too much to qualify for the Medicaid program for the poor, but not enough to afford their own, private health insurance. The bill the president vetoed would have added $35 billion to the program over the next five years — enough to cover about 10 million children total.

"I believe in private medicine," Bush told an audience in Lancaster, Penn., on Wednesday morning. "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."

Not Administered by the Government

But SCHIP isn't the kind of program where government officials make medical decisions. Under SCHIP, children are enrolled in private health insurance.

"Typically, children have a choice from among competing private health-insurance companies," says Stan Dorn, a senior research associate with the Urban Institute, a Washington-based think tank. "There's no federally specified benefits package. There's no individual entitlement."

The president also complained that the bill would cover too many children who don't need federal help. "This program expands coverage, federal coverage, up to families earning $83,000 a year. That doesn't sound poor to me," the president told the Lancaster audience.

Dorn says that's not exactly right, either. "This bill would actually put new limits in place to keep states from going to very high-income levels. SCHIP money would no longer be available over 300 percent of the federal poverty level, which is about $60,000 for a family of four."

The president gets to make the $83,000 claim because New York had wanted to allow children in families with incomes up to four times the poverty level onto the program. That is, indeed, $82,600. The Department of Health and Human Services rejected New York's plan last month, and under the bill, that denial would stand. White House officials warn, however, that the bill would allow a future administration to grant New York's request.

Health Care Confusion for All

Still, Dorn says the real irony is that the bill, which was negotiated largely by Republicans in the Senate, goes a long way toward meeting the goals that Bush said he wanted for the program.

"It's limited the ability to go up the income scale. It's focused resources on the poorest uninsured kids. It's imposed new duties on states to prevent government funds from crowding out employer coverage," Dorn says.

In other words, the bill addresses all of the president's complaints, including his concern that families with private coverage now will drop it in favor of government-subsidized care.

But it's not just the president who is confused; Democrats are, too. Last week, at a news conference, House Majority Leader Steny Hoyer told the story of 12-year-old Deamonte Driver, the Maryland boy who died earlier this year after an untreated abscessed tooth turned into a brain infection.

"He had a toothache," Hoyer said, "but he didn't have health insurance, and his folks could not access dental care."

Actually, Deamonte Driver did have health insurance. He had Medicaid. His mother just couldn't find a dentist who would accept that Medicaid coverage — which is a whole different problem.

Meanwhile, Congress has continued funding for the SCHIP program through mid-November while the bigger battle plays out. A House override vote on the president's veto is now scheduled for Oct. 18.



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