Liberty Street: Bush Moves To Prevent States From Expanding Health Care Coverage for Children

Not content with sabotaging Congress's attempt to expand health care coverage for children whose families can't afford it, Pres. Bush is now trying to prevent individual states from doing so:

The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.

Administration officials outlined the new standards in a letter sent to state health officials on Friday evening, in the middle of a month-long Congressional recess. In interviews, they said the changes were aimed at returning the Children’s Health Insurance Program to its original focus on low-income children and to make sure the program did not become a substitute for private health coverage.

After learning of the new policy, some state officials said today that it could cripple their efforts to cover more children by imposing standards that could not be met.

Ann Clemency Kohler, deputy commissioner of human services in New Jersey, said: “We are horrified at the new federal policy. It will cause havoc with our program and could jeopardize coverage for thousands of children.”

Stan Rosenstein, the Medicaid director in California, said the federal policy was “highly restrictive, much more restrictive than what we want to do.”

The poverty level for a family of four is $20,650 in annual income. New York now covers children in families with income up to 250 percent of the poverty level. The State Legislature has passed a bill that would raise the limit to 400 percent of the poverty level — $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.

As on other issues like immigration, the White House is taking action on its own to advance policies that were not embraced by Congress.

In his budget request in February, President Bush proposed strict limits on family income for the child health program. But in voting this month to renew the program for five years, neither house of Congress accepted that proposal for the program, whose legal authority for the child health program expires on Sept. 30. The policy in the Bush administration’s letter would continue indefinitely, although Democrats in Congress could try to pass legislation overriding it.

The Children’s Health Insurance Program has strong support from governors of both parties, including Republicans like Arnold Schwarzenegger of California, Tim Pawlenty of Minnesota and Sonny Perdue of Georgia. When the Senate passed a bill to expand the program this month, 18 Republican senators voted for it, in defiance of a veto threat from Mr. Bush.

In the letter sent to state health officials about 7:30 p.m. on Friday, Dennis G. Smith, the director of the federal Center for Medicaid and State Operations, set a high standard for states that want to raise eligibility for the child health program above 250 percent of the poverty level.

Before making such a change, Mr. Smith said, states must demonstrate that they have “enrolled at least 95 percent of children in the state below 200 percent of the federal poverty level” who are eligible for either Medicaid or the child health program.

Deborah S. Bachrach, a deputy commissioner in the New York State Health Department, said, “No state in the nation has a participation rate of 95 percent.”

And Cindy Mann, a research professor at the Health Policy Institute of Georgetown University, said, “No state would ever achieve that level of participation under the president’s budget proposals.”

The same right-wing apologists for Pres. Bush's refusal to sign the SCHIP budget increase back in July are again defending Bush's imposition of onerous new rules meant to prevent expansion of SCHIP coverage even on the state level:

... [M]any of the children [who would be insured under expanded SCHIP coverage] are those of middle class families who have access to or are already covered under private health insurance plans[.]
[...]
This is simply an underhanded attempt to incrementally expand government welfare to a new level - an important step down the road to single-payer, government run health insurance.

Of course it is being characterized as an attempt to deny poor children "free" health care. It's not. It specifically denies the attempt, by some states, to raise the bar for acceptance to 400% over the poverty rate which means the inclusion of some households making $80,000 a year and "children" up to the age of 25.

In case it's not clear what's being advocated above, here it is: The profits of private insurance companies are more important than the health of low- and middle-income children. Scarecrow at Firedoglake points out that this attitude is not just morally corrupt; it's economically indefensible, and contradicts basic free market ideology:

The Bush Administration and its Republican Congressional allies seek to justify this latest outrage by claiming that SCHIP was meant only to help those children at or below the poverty line. That may have been its original rationale, but so what? There is no public policy reason to limit a children’s health care system that is highly successful, improves public health, is endorsed by governors of both parties, and costs less than private insurance schemes that don’t work as well (because of the perverse incentives private insurance schemes have to deny or limit coverage to lower their costs and increase profits). Nor is there even a “conservative” policy justification for subsidizing a private insurance scheme merely for the purpose of making it appear “competitive,” when in fact it is more costly (as well as less effective in providing actual care). That’s phony competition, subsidized by tax payers, and even Republicans should oppose that.

This is a simple case of insurance company greed and influence coupled with the Bush Administration’s complete distortion of ideological preference for markets. This isn’t genuine competition. Instead, here we see the hand of government using subsidies or penalties to tip the scales to favor private schemes that are more costly and less desireable, with two inevitable effects: (1) fewer children will receive health care and (2) it will cost more for those who do. So much for “compassionate conservatism.”

The new rules are bad public policy no matter how you look at them; it’s bad market economics, bad fiscal policy, bad health care policy, bad conservative principles and most of all, it’s bad for kids. It’s just plain bad for America. But it’s exactly what you would expect from the worst President ~~since . . . ??~~ ever. DemFromCT has more at The Next Hurrah. Check out the linked poll showing overwhelming support for expanding SCHIP, even if it means higher taxes. [h/t Peterr] And N=1 point us to this excellent health blog that also covered the story.

Frank Pasquale debunks the notion that Bush is just trying to keep families who can well afford to buy private insurance from abusing the system:

One quick question here: is there any allowance for cost of living differences? Given the Manhattan real estate boom, a family on the very upper end of the proposed New York eligibility level--making $82,600 a year--might easily spend more than half of its disposable income on rent, and be hard-pressed to find insurance. Moreover, New York's "Warhol economy" makes many workers even more vulnerable to income swings than the rest of America. Finally, consider the plight of those employed by small businesses: only 47% of firms employing 3-9 workers even offered health insurance in 2005, and the individual health insurance market is not exactly a picnic for those in less-than-perfect health:
Consumers who are in less-than-perfect health clearly face barriers to obtaining health insurance coverage in the individual insurance market. Insurance carriers often decline to cover people who have pre-existing medical conditions, and even when they offer coverage, frequently impose severe limitations on the coverage for any expenses related to the pre-existing condition or charge more to cover these expenses.

Conservatives are impervious to these sorts of "anecdotal" or "emotional" arguments. Conservatives see most issues in terms of metrics -- mathematical formulas for the way things should work -- only for those who are mad for metrics, the "should" doesn't even occur. Anyone with an income of $80,000 a year is financially secure anywhere in the United States -- and if they're not, it's because they refuse to make better choices:

... I know a lot of conservatives feel that, so long as one has a job of any kind, whatever financial problems one may have can be solved by lifestyle changes. Get a smaller house/apartment. Don't have a car. Eat nothing but ramen noodles, don't ever turn on any lights and get your water from a creek. With that in mind I can see how the Bush Administration would want to resist expansion of the program or institute stricter means testing for new enrollees. And doing so would reduce the cost of the program, which is in line with the Republican principle of fiscal "responsibility" for every program that might in some way benefit someone who is not rich.

But the changes that the Bush Administration is making are simply ridiculous:
Under the new policy, a state seeking to enroll a child whose family earns more than 250 percent of the poverty level -- or $51,625 for a family of four -- must first ensure that the child is uninsured for at least one year. The state must also demonstrate that at least 95 percent of children from families making less than 200 percent of the poverty level have been enrolled in the children's health insurance program or Medicaid -- a sign-up rate that no state has yet managed.

If you have a child and don't have health insurance, every day is stressful. Should your child play sports? What about school recess? A friend of ours had to take their daughter to the hospital recently because she and some friends had decided to go to their basement, tie a rope to the rafter and swing from the basement stairs toward the metal support pole in order to be able to slide down it like a firehouse pole. Somehow this brilliant plan went awry and the girl in question broke her arm.

Kids do these things. It's not even wrong. Let's face it: human beings are all enrolled in the school of hard knocks because we are rarely able to learn any other way. Given that two kids plucked at random are going to be pretty much the same in the way that they sometimes use good judgment and sometimes rather poor judgment, why should one kid be punished simply because her parents don't make as much money as the other kid's folks?

One might also ask why children should forego health care because the man who holds the highest office in their country makes bad -- extremely bad -- choices about funding priorities:

In Steps:

1.) Spend absolutely massive amounts of money on a number of programs, expanding spending leaps and bounds beyond your predecessor.

2.) Fund an extremely expensive and increasingly unpopular war that has, literally, no end in sight, and even if ended tomorrow, would continue to cost extraordinary amounts of money.

3.) Finally take a stand on spending, but choose to do so on an expansion of a popular Children’s Insurance Program that will be impossible to defend politically (especially since 6 of 10 Republicans on the finance committee voted for it) and do so in a way that makes sure it looks like you are trying to do something underhanded (like, for example, issue new rules).

4.) Watch as members of your own party, already terrified at their election prospects in 2008 due to the rank incompetence of your administration and sheer unpopularity of all your other decisions, race from your position, unable to explain why you chose this, of all programs, to take a stand.

5.) Enjoy yet another permanent expansion of the bloated United States budget.

The Bush Administration in a nutshell.

This is a conservative administration? Of course, it isn't [all emphasis is Joe's]:

We have said it several times before and some folks get mad and start the “how can you call yourself a moderate” mantra. But we’ll say it again:

You almost can’t be a moderate anymore and be silent as you read this New York Times piece, only the LATEST in a seemingly endless series of Bush Administration Outrage Stories Of The Day that are increasingly defended by the administration’s rapidly shrinking number of lockstep supporters. The Bush administration is not a “conservative” administration — but an increasingly radical one.

Keep in mind that this story is surfacing as some GOPers continue to talk about the need for tax cuts.

Here’s a key quote from an AP story:
The new guidelines could have a dramatic impact on those states as well as any other that wanted to follow in their steps, said Cindy Mann, executive director of the Georgetown University Center for Children and Families.

“It’s a pretty radical departure in policy that has been in existence for 10 years,” Mann said. “It attempts to stop in their tracks those states that have already or want to expand coverage.”

So this is no longer matter of the administration just battling a Congressional move to EXPAND this plan.

This is a matter of the administration TAKING AWAY part of this plan from states that already offer coverage go some kids. (I personally know of a 12 year old girl here in California who just learned she has a bad kidney. She is insured by the same insurance GWB is now trying to eliminate.).