In Washington this week, the White House renewed George W. Bush's war against children's health care that dates back to his days as Governor of Texas. Just two weeks after the House and Senate each approved major expansions of the State Children's Health Insurance Program (S-CHIP), the Bush administration announced draconian new eligibility rules that would trim thousands of low income children from the rolls. But unlike his Texas two-step when he claimed credit for a program he fought tooth and nail, this time George W. Bush isn't running for anything.
As the New York Times described, the White House quietly dispatched a letter at 7:30 PM on Friday evening outlining its new curbs on S-CHIP eligibility. With Congress out of session, Dennis Smith of the federal Center for Medicaid and State Operations notified states that they must reach 95% enrollment of families below 200% of the poverty level before they can expand their programs. Of course, no state currently approach the 95% figure today (nationally, almost 30% of eligible children remain unenrolled in S-CHIP). Worse still, several states previously received the federal government's OK to extend their coverage to even higher income levels and more are considering further expansion still:
In New York, which covers children up to 250 percent of the poverty level, the Legislature has passed a bill that would raise the limit to 400 percent - $82,600 for a family of four - but the change is subject to federal approval.
California wants to increase its income limit to 300 percent of the poverty level, from 250 percent. Pennsylvania recently raised its limit to 300 percent, from 200 percent. New Jersey has had a limit of 350 percent for more than five years.
It's no wonder incredulous state health care officials are horrified by the Bush administration's new regulations. Ann Clemency Kohler, deputy commissioner of human services in New Jersey, said "It will cause havoc with our program and could jeopardize coverage for thousands of children."
If this all sounds vaguely familiar, it should. As I wrote last month ("S-CHIP on Bush's Shoulder"), the unfolding saga over children's health insurance is a repeat of then-Governor George W. Bush's performance in Texas. There, Bush first opposed the S-CHIP program and then tried to limit its scope with restrictive income eligibility requirements. Facing certain defeat over the popular program, Governor Bush ultimately caved to public pressure. Of course, he then took credit for it.
As The New Republic noted, we've been here before. In the 1990's, then Texas Governor George W. Bush opposed a bi-partisan effort to expand S-CHIP in his state. Despite Texas' worst-in-the-nation status (then and now) in the percentage of residents without insurance, Bush (then as now) opposed the broadened program on both fiscal and philosophical grounds. As Salon reported in July 2000, Bush tried to limit eligibility to families with incomes at 133% of the poverty line, compared to the 200% standard adopted in most states (and over Bush's opposition, in Texas). Bush's hard line would have kept 200,000 kids off the program's rolls. As it was, the difficult and cumbersome application process limited sign-ups to only 28,000 of the 500,000 children eligible by mid-2000.
None of which stopped George W. Bush taking credit for the program during his 2000 presidential campaign. As Joshua Micah Marshall reported in Salon:
In Bush's press release it says: "When the CHIPs program was first implemented, Governor Bush embraced it as an opportunity to help deliver health coverage to thousands of uninsured children, and signed legislation providing health insurance for more than 423,000 children."
On July 20, 2000, Al Gore made a trip to San Antonio, Texas. Gore described Governor Bush's opposition to the program and the onerous eligibility process he set up to blunt participation by Texas families. "As a result," Gore said, "there are 600,000 children in Texas eligible for health insurance who don't have it." Sadly, Bush never paid a price for stonewalling on S-CHIP and his war against Texas' children.
Fast forward to 2007 and it's deja vu all over again but with one important difference: this time, George W. Bush isn't running for anything. All of which raises the question: Will Bush once again yield to public pressure on S-CHIP expansion and then take credit for it?
The emerging dynamic of the 2008 campaign suggests not. Unlike 2000 and 2004, George W. Bush is not on the ballot and so does not need a children's health care program or Medicare prescription drug coverage to boost his chance. More importantly, the clear GOP strategy for 2008 calls for obstructionism at all costs. That is, through Senate filibusters and presidential vetoes, Republicans aim to prevent Democrats from claiming credit for virtually anything and thus position Harry Reid and Nancy Pelosi as failed leaders of a do-nothing Congress.
That contest remains to be played out. But in the mean time, President Bush is ensuring that the real losers will be America's children. Just like he did in Texas.
(For more on the Bush modus operandi on health care of opposing needed and popular health care programs but then claiming ownership of them after they pass despite his efforts, see ("S-CHIP on Bush's Shoulder.")