Having followed this story closely here since this Sat, Sept. 22 post, I have been thinking about the state of play at the moment with SCHIP and where we go from here politically. This 12/20 summary is from kaisernetwork.org:
SCHIP Outlook
White House spokesperson Dana Perino in a statement said, "With this (SCHIP) bill, we can be assured that children will continue to have coverage, and Democrats won't be able to play election-year politics with children's health" (Neikirk, Chicago Tribune, 12/20).
The measure does not address an SCHIP policy directive announced in August by CMS that states must enroll 95% of children in families with incomes up to 250% of the federal poverty level before expanding eligibility, The Hill reports. Acting CMS Administrator Kerry Weems said that the Bush administration would not require states to disenroll children from the program despite the requirement. House Energy and Commerce Committee Chair John Dingell (D-Mich.) said that Weems' statement contradicts the policy, adding, "Perhaps CMS officials are reading their directive differently than the rest of us."
An analysis by the Georgetown University Health Policy Institute's Center for Children and Families found that 14 states provide SCHIP coverage to children in families with incomes greater than 250% of the poverty level and that they "will likely be forced to roll back their eligibility levels at some point before August 2008 or assume new coverage costs with state funds." Democratic Caucus Chair Rahm Emanuel (Ill.) on the House floor Wednesday said, "Because of the president's executive order, kids in those states will actually come off the rolls in August." The National Governors Association on Monday sent a letter to Congress asking it to "address the issue raised in the ... guidance issued by CMS" (Young, The Hill, 12/20).
[Rahm] Emanuel said SCHIP will be addressed this summer, when the new rules take effect. He said, "What we can't resolve, the American people will resolve in November," adding, "This will be the first thing a Democratic president will get done. We don't need March '09" (Johnson, CongressDaily, 12/19).
So, without defending (or piling on) the Democrats in Congress, who are having issues with caving on Iraq and perhaps a few other items, I would have been happier with more public votes. However, reality sometimes intrudes, and here are some realities:
- Some states, at least, were running out of money. Georgia, for example:
The latest plan would extend funding for PeachCare and other programs like it around the country through March 2009 - a timeline first proposed by Rep. Nathan Deal, a Duluth Republican who took a leading role in previous negotiations on SCHIP.
The Baucus-Grassley measure would keep PeachCare funding at its current levels. But it would add additional funds to prevent Georgia and about 20 other states from running out of money early - a problem that this year forced Georgia lawmakers to freeze and cap enrollment for the state’s eligible children...
"With appropriate funding," she said, "children already enrolled and eligible for PeachCare can continue without interruption of their health care."
Since Oct. 1, PeachCare has been operating under month-long - and, in the latest case, weeklong - extensions of its current funding, leaving Georgia officials worried about running out of money in early 2008.
While it made political sense to fight up to the edge, Georgia went over the edge 10/1 and could not enroll new children (who, despite government caps, have a habit of piling up when you are not paying attention).
- The Senate, a 'safe haven' that reached 67 yea votes, was not stable. Orrin Hatch and Charles Grassley, in particular, showed signs of wavering under pressure from Rs in the House. Further votes might have given the GOP the appearance of momentum (even if untrue).
Finance Committee ranking member Chuck Grassley (R-Iowa) maintained that the lengthier SCHIP extension would actually help Congress tackle a larger bill in 2008. "The longer extension of SCHIP will allow Congress to enter the new year with a renewed focus on reauthorization while also providing funding certainty to states," he said. Grassley has been at the center of the SCHIP and Medicare debate all year, even helping the House Democratic leadership’s efforts to flip House Republicans to their side.
- Intransigent House Republicans were not going to waver. As bad as the SCHIP vote was for them at home (and it was), flip-flopping in their minds was worse.
- It's foolish to play chicken with someone intent on suicide. If a tie is a loss, then you cannot possibly win. George Bush had no intention of passing a SCHIP bill. He had no interest in negotiating, and Dems would not have trusted him if he did.
- As is suggested in the story, with health care rising as an issue of concern, this remains a potent weapon for the Democrats in November. If Republicans are thinking they've escaped an Iraq issue (they haven't, but no one accused the GOP of being very bright), and want to replace it with domestic issues for the election, they have a long term problem they don't even understand yet.
All of the above puts the current state of play in context. OTOH, we need to make sure Rahm and the
Dem leadership are accountable for making sure SCHIP stays on the table politically.
Republicans who believe they have postponed the next fight over SCHIP until 2009 and that that postponement provides them with political cover will be proved wrong, Pelosi’s spokesman said. States and outside groups will continue to bring pressure on Congress to do more on SCHIP next year, he added.
Likewise, the Democratic leadership aide predicted that voters would remember votes against the larger SCHIP bills next November, regardless of what happens throughout 2008. "That vote is still incredibly important and still incredibly powerful," the aide said.
And another reminder of the Big Picture:
As they face the voters in a presidential election year, Republicans will have to explain their loyalty to Mr. Bush’s war policies when polls have been clear for months about public dissatisfaction with the war. Even the relatively positive military trends that some see in Iraq have not, so far, produced much in the way of social stability there.
Democrats will remind voters at every turn that Republicans fought the expansion of health insurance for children and higher federal spending on biomedical research, college aid and an entire spectrum of federal programs.
"Many are paying and will continue to pay a price, but they are standing by the president and their most conservative base," said Senator Richard J. Durbin of Illinois, the No. 2 Democrat in the Senate. "The general polling across the country suggests this will not work in November."
And, longer term, if we want real reforms passed in health care:
- Public health needs to be on the table just as much as health care for support and reform
- We need more and better Dems in the Congress
- We must have a Democrat in the White House (perhaps one or two of you have an opinion you'd like to share as to which one?). Bush's term in office shows why "who is in the White House" matters. Anyone who (post-2000) still thinks "there's not a dime's bit of difference between the parties" is a fool or a liar or both.
GOP rejection doesn't mean there's auto-approval of Democrats. They still need to bring something to the table to gain the support they need to win. Still, I remain optimistic on all counts, and look forward to November 2008, which can't come a moment too soon.