Update [2007-9-22 12:46:39 by DemFromCT]: Public Weighs In on the Side of the Democrats in the Debate About the State Children's Health Insurance Program. (h/t PatriciaVA).
One of the oddest stories developing is the Republican campaign against children and families. In this case, we are talking about the State Children’s Health Insurance Program (SCHIP). For example, from the Atlanta Journal-Constitution:
The Good News: House and Senate negotiators struck a deal on PeachCare’s parent program Friday that would expand the program by $35 billion.
The Bad News: President Bush already announced he’d veto it.
The SCHIP program has been a great success by all accounts. This issue brief by Mathematica is a good read for anyone wanting to come up to speed on the topic. Mathematica's 7 year study of SCHIP was submitted to the Feds as part of the deliberative process.
Why SCHIP?
SCHIP was enacted at a time when the number and rate of uninsured children were growing rapidly, especially among those just above the poverty threshold— too poor to purchase private coverage but not poor enough to qualify for Medicaid. Recognition of the large number of uninsured children eligible for Medicaid but not enrolled was also mounting. When Congress launched SCHIP as part of the Balanced Budget Act of 1997, it gave states considerable flexibility in designing programs to expand coverage for uninsured low-income children. They could expand coverage through Medicaid (M-SCHIP), create a separate child health program (S-SCHIP), or combine the two approaches. SCHIP represented the largest expansion of publicly sponsored health insurance coverage since Medicare and Medicaid were created in the mid-1960s.
This chart shows the growth in the program (i.e. successful recruitment).
And as for the bottom line results:
Fewer Uninsured Children
SCHIP improved health coverage among low-income children. Using data from the Current Population Survey, we found that, between 1997 and 2003, the proportion of children under age 19 who were uninsured decreased from 16 to 13 percent. The uninsured rate among low-income children declined by an even larger amount, from 25 to 20 percent. The number of uninsured, low-income children fell by nearly one-third, from 7.9 to 6.1 million.
SCHIP also served as a safety net for low-income children during the 2000 recession and beyond, when many families lost employer-sponsored coverage. Although children and nonelderly adults experienced similar losses of private coverage between 2000 and 2003, earlier gains in children’s coverage were sustained through continued growth in public coverage, largely attributable to SCHIP. In contrast, nonelderly adults, including parents and childless adults, lacked access to much of this public coverage, and their uninsured rates increased significantly (Figure 2).
(Full figure 2 available from source)
So, while it is not universal health care, it is a major step in helping children get the medical and dental care they need.
We, of course, make some assumptions here. One is that having medical insurance is a good thing. Another is that it improves access to care, without which quality medicine (not measured here) does no good to the patient. That's at least a demonstrable assumption:
Access to Health Care Improved
Access to care has improved for children enrolled in SCHIP, although gaps remain. Evidence from the literature and state monitoring efforts suggests that SCHIP increased the likelihood of having a usual source of care, reduced the level of unmet need, and improved access to dental care. Two subgroups— the long-term uninsured (those without coverage for more than six months before SCHIP) and adolescents— saw the greatest gains under SCHIP. Two other subgroups—those with special health care needs and members of minority racial or ethnic groups— were less likely to post consistent gains. Although disparities have lessened, substantial gaps remain.
So why not just reauthorize the legislation? Well, it's not just the money; that's where ideology comes in. You'll see it in Bush's quotes aboutn the bogieman of 'socialized medicine'. There is a tendency to use SCHIP instead of private insurance, which is known as "substitution" or "crowd out" and estimates vary widely (the range is presented in the report). If you use the higher estimates (10 to 56%, you have a data point to sound the alarm. If you use the lower estimates (0.l7 to 10%), it appears to be a non-problem. The report explains why the lower estimates are likely to be more accurate, as the "study limitations" of the higher numbers open them to question.
In the end, Mathematica notes
If SCHIP did not exist, we estimate that the rate of uninsured children would have risen by 3.3 percentage points, instead of declining by 0.7 percentage points between 2000 and 2003. Furthermore, we estimate that the number of uninsured children would have grown by 2.7 million, rather than declining by 0.4 million. These measures illustrate how the availability of public coverage protected many low-income children from becoming uninsured between 2000 and 2003.
That's why the American Public Health Association, pediatricians and public health advocates have worked to expand SCHIP to cover as many children as can be afforded.
Thousands of pediatricians across New York State reacted with puzzlement, frustration and anger to the federal government’s rejection of New York State’s effort to expand the Children’s Health Insurance Program.
"The federal denial flies in the face of reality," said, Dr. Henry Schaeffer, Chair of the Academy of Pediatrics, District II, NYS. "Recent census data indicates that more and more Americans and more and more New Yorkers are losing employer based health coverage, and yet the federal government denies New York’s effort to offer health insurance to more uninsured children. This makes no sense." said Dr. Schaeffer.
The votes are there in the Senate to override a veto, but the House is shakier.
House Republicans pledged on Wednesday to vote against a measure like the one now being offered, saying it would raise taxes and let states continue to enroll kids from families with enough money to buy private insurance.
Please note that after Iraq, health care routinely turns up as the big concern on public opinion polls. At the moment, the GOP looks like it'll be running not only to support Bush's war in Iraq, but to deny basic medical care to children. They are making themselves into sitting ducks in 2008 the closer they tie themselves to the lame duck in the WH. And that, folks, is the way it is.
Update [2007-9-22 10:9:8 by DemFromCT]: See also StrangeAnimals' diary, same topic.