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A battle over children's health is affecting which kids are getting federal help. The State Children's Health Insurance Program, known as SCHIP, was designed to cover children and families too poor to afford private insurance but not poor enough to get Medicaid.
The Bush administration wants to make an even finer distinction. It's telling states to take care of the very poorest children before providing care to kids whose families have a little more money.
It sounds straightforward, but as NPR's Julie Rovner reports, many states are claiming the new requirement will cause nightmares for some families.
JULIE ROVNER: At issue was a letter Bush officials sent out last August. The letter said that starting this August lower income children should get coverage before those in families that earn more. As a result, some states have already been forced to cancel their expansion plans.
In Ohio, the cancellation has left all three of Paula Novak's children uninsured, including four-year-old Seth, who was born with Down syndrome. At a Senate hearing yesterday, Novak says he's been hurt the most by missing needed care.
Ms. PAULA NOVAK: Seth had open-heart surgery in 2007 and missed his one-year cardiology follow-up. Seth has missed appointments for eye exams, thyroid exams, ENT visits to replace tubes in his ears, genetic doctor appointments to track his growth and development, fittings for his orthotics, and very importantly - because Seth is still nonverbal - visits to his speech therapist.
ROVNER: Democratic lawmakers in particular have been outraged by the administration's action. Because of the change states will no longer by able to enroll children in the SCHIP program in families with income over 250 percent of poverty, that's about $44,000 for a family of three, unless the state can prove it's already enrolled 95 percent of children in families at two times poverty, about $35,000.
West Virginia Senator Jay Rockefeller, who chaired the hearing, accused the administration of having motives beyond prioritizing coverage of poor children.
Senator JOHN ROCKEFELLER (Democrat, West Virginia): In my judgment its aim is simple: to make it virtually impossible to provide greater access to health insurance for children. This is repugnant.
ROVNER: But Dennis Smith, who heads the SCHIP program for the Bush administration, defended the change. He said many states would be just fine.
Mr. DENNIS SMITH (SCHIP Administrator): Currently there are 17 states above 250 percent of the federal poverty level. Based on our discussions with them, at least nine of those states, based on their data and the guidance that we have provided, will in fact meet that 95 percent threshold.
ROVNER: But the calculations the administration is using - counting children as covered, for example, even if they only have insurance for a small part of the year - have led to accusations of fuzzy math. Here's how Congressional Budget Office director Peter Orszag put it when he was asked to judge the administration's methodology.
Mr. PETER ORSZAG (Director, Congressional Budget Office): It reminds me of the joke about the guy who won a lottery by picking the number 36. And someone said why'd you pick 36, and he said, well, I've got six grandkids and their average age is seven and six times seven is 36.
ROVNER: In other words, the administration's calculations don't make a lot of sense. Alan Weil of the National Academy of State Health Policy said there's another reason to continue to allow states to enroll higher income children in their SCHIP programs.
Mr. ALAN WEIL (National Academy of State Health Policy): States have found that higher eligibility levels are an effective means for attracting lower income children into the program. Broadening eligibility reinforces the message that health insurance programs are not tied to welfare and that they are designed for working families.
ROVNER: Democrats have vowed to overturn the Bush policy in legislation before it takes effect this August, but they'll need enough Republicans to override a near certain presidential veto. And so far it's not clear whether they'll get them.
Julie Rovner, NPR News, Washington.