SCHIP: Govs. Spitzer and Schwarzenegger Call on Bush to Reverse New Rules
Wed Aug 29, 2007 at 05:56:19 PM PDT
In an unusual, but hopefully not unique, example of bipartisan cooperation, Governors Eliot Spitzer and Arnold Schwarzenegger joined together today in a letter to President Bush calling for the withdrawal of new rules proposed by the Centers for Medicare and Medicaid Services (CMS) relating to the State Children’s Health Insurance Program (SCHIP).
As noted in Gov. Spitzer's press release (and discussed extensively in a wide variety of diaries here at Daily Kos, two weeks ago CMS announced that under the new rules, "until a state enrolls 95 percent of those eligible for SCHIP in households making under 200 percent of the poverty line ($41,300 for a family of four), they cannot provide coverage to children in families making above 250 percent of the poverty line ($51,625 for a family of four)." Not only is this a horrible idea on its own, but it would be a disaster for children in states with higher costs of living.
In a helpful summary provided by the Kaiser Family Foundation on some of the initial reaction to the proposed changes, it becomes clear that the whole point of altering the rules is to limit the scope of a successful government program. Not a single state would be able to expand SCHIP (Vermont comes closest to the 95% figure, which probably isn't surprising given the demographics of the state) at a time when we've just seen the numbers of the uninsured increase over the past year by another 2.2 million.
And in his New York Times column yesterday (behind the firewall, as always), Bob Herbert observed:
Acting during a Congressional recess, and making a distinct effort to stay beneath the radar of the news media, the administration enacted insidious new rules that make it much harder for states to bring additional children under the umbrella of the program, known colloquially as CHIP.
The program is popular because it works. It’s cost effective and there is wide bipartisan support for its expansion. But President Bush, locked in an ideological straitjacket, is adamant in his opposition.
In addition to the new rules drastically curtailing the ability of governors to expand local coverage by obtaining waivers from the federal government, the president has threatened a veto of Congressional efforts to fund a more robust version of the overall program.
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The reality is that under the administration’s approach enormous numbers of children in families without a lot of money will be left with no coverage at all, private or otherwise. The expansion of CHIP is the most efficient, cost-effective way of reaching those youngsters.
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What’s happening is cruel. Children who should be eligible for CHIP are being held hostage to policies driven by a desire to protect the big insurance companies and an ideology that views CHIP, correctly, as yet another important step on the road to universal health care.
It should be noted that even some hard-core traditional conservatives would presumably find the new rules hard to swallow. Sen. Orrin Hatch, hardly a bastion of radical leftist thinking, recently said of SCHIP, "These aren't people on welfare. These are children of working-poor parents who are trying to work but don't have the money to get health insurance. It's hardly welfare." Hatch has been behind the program since its inception in the 1990s.
As described in their joint press release, the two governors today
also asked CMS to repudiate other troublesome new rules, including the requirement that children eligible for SCHIP must go without coverage during a year-long waiting period after enrolling, and that states expanding SCHIP must have a less than 2 percent decline in employer-sponsored insurance.
Although I'm a complete layman in terms of health issues, it's pretty obvious that not only is it heinous to force children to wait a whole year before coverage becomes effective, but that the latter requirement is little more than a sop to those private insurance companies in the hope of goosing a lot more in terms of campaign donations to the GOP. I can only assume that SCHIP is significantly more efficient and cost-effective than private insurers, since this is the case with most other government-run or -sponsored health care programs (despite what the insurance industry and Republican propagandists might have you believe).
The proposed rules also fly in the face of the clear intent of Congress regarding SCHIP reauthorization in somewhat different bills passed shortly before the August recess. The House version would reduce payments to private Medicare Advantage plans while increasing the federal cigarette tax by 45 cents per pack (never a bad thing, anyway) in order to increase funding for SCHIP by about $50 billion over five years. The Senate plan would more simply raise the cigarette tax by 61 cents per pack to generate an additional $35 billion for SCHIP over five years. Our Dear Leader in the White House, however, only wants a $5 billion increase over the same period, and has threatened to veto either the House or Senate versions. Mustn't be profligate in our spending, since the Administration is such a firm believer in fiscal restraint!
The governors note that between California and New York, more than 1.4 million children and pregnant women are currently covered by SCHIP, some 25% of the national total. And whatever happened to that whole right-wing concept of giving states far broader discretion to set up programs of their choosing and to modify them to suit their needs? Isn't that supposed to be the point of federalism and states' rights? Yet here, the governors note,
We agree with your push for states to be a force for change in the delivery of health care to tens of millions of our fellow Americans who remain without meaningful coverage. But as you rally governors to do more to help fix our broken health care system, your administration has repeatedly modified existing Medicaid and SCHIP rules, harming states’ capacity to help you achieve our shared objectives.
The recently proposed SCHIP rules will reverse longstanding agreements with the states and reduce the number of children who receive health care. We strongly urge you to reconsider these recent policy changes, which simply diminish state flexibility.
We agree with your administration’s goal of trying to deter families from dropping private coverage in favor of SCHIP, which is why most states have adopted reasonable waiting periods with limited exceptions for involuntary loss of coverage. But the rules proposed by CMS would install thresholds that are impossible to meet for nearly every state and impose a one-size-fits-all solution to a dynamic and complex problem.
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The administration should maintain the innovative responsibility granted to governors under SCHIP, thereby continuing the enormous success of the program. Flexibility in benefit design and administration under SCHIP, as well as Medicaid, has improved efficiency and contributed to a one-third reduction in the rate of uninsured low-income children since 1997.
I can't write specifically about the Governator's recent activities on behalf of SCHIP, but Spitzer has clearly gone on a major offensive this week: even before today's letter to Bush, he had written an op-ed in the NY Daily News, as well as an aggressive piece for the Huffington Post. In that latter effort, the Steamroller pulls no punches:
Sometimes in politics, you think you've seen it all. Turns out I was wrong. Just when you thought things at the White House couldn't get any stranger, the president has decided it is good public policy to increase the number of uninsured children in our country.
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Make no mistake. This is a poison pill meant to deny thousands of children health insurance.
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This isn't about fiscal restraint. The initiative is paid for through a tax on unhealthy cigarettes and other revenue sources. This isn't about good public policy. SCHIP has been wildly successful in providing health care for nearly seven million of our nation's vulnerable children.
The actions of the White House speak to what we've all known for far too long. When faced with the choice of covering thousands of children, they'll bring up the "big government" bogeyman and then stick their heads in the sand, ignoring the realities facing working families across the country.
Gov. Spitzer indirectly refers to his prior announcement that he might have the state "fight the new federal administrative rules in court on the grounds that they contradict the provisions of the federal SCHIP law and were imposed without notice or the required comment period." It will be interesting to find out whether Schwarzenegger would be willing to join him in court (or if any other states hop along for the ride as well). As most of you know, Spitzer isn't exactly known for his delicate treatment of his opponents, or for an unwillingness to bring legal action to get his way.
In any event, it could be a very bumpy ride for all concerned over the next few weeks, with various states and Congress lining up on one side, and the increasingly beleaguered Bush Administration on the other. With the health of millions of America's children hanging in the balance, one can only hope that the Administration will back down -- which would only occur not because it's the right thing to do, but because it could win back a tiny fraction of popularity.
Again, as a casual observer here without any deep understanding of SCHIP at all, what strikes me as most absurd is that in purely financial terms, this whole fight comes down to just a few billion dollars per year -- a mere week or two of what it costs to keep our troops in Iraq. Put that way, anything less than abandonment of these proposed rule changes and expansion of SCHIP along the lines adopted by Congress is tantamount to a form of child abuse.
Let us all hope that Spitzer and Schwarzenegger's letter helps bring the Administration around.
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