Bush Acts to Limit Health Plan for Children

[lancelva]

This is even more proof of why we need a Democratic President and a stronger majority in Congress.

Not to mention more proof that Bush and his allies are in the pocket of private health insurance companies. Just like with NCLB, the Bush Administration is demanding the impossible from states.

White House Acts to Limit Health Plan for Children

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 Congressional Budget Office has said that the president’s budget, which seeks $30 billion from 2008 to 2012, is not enough to pay for current levels of enrollment, much less to cover children who are eligible but not enrolled.

When Congress created the Children’s Health Insurance Program in 1997, it said the purpose was to cover “uninsured low-income children.” Under the law, states are supposed to make sure public coverage “does not substitute for coverage under group health plans;” but the law did not specify what states must do.

In an interview today, Mr. Smith said: “The program was always meant for children in lower-income families. As states move higher up the income scale, it’s more likely to substitute for private coverage.”

To minimize the risk of such substitution, Mr. Smith said in his letter, states should charge co-payments or premiums that approximate the cost of private coverage and should impose “waiting periods,” to make sure higher-income children do not go directly from a private health plan to a public program.

If a state wants to set its income limit above 250 percent of the poverty level ($51,625 for a family of four), Mr. Smith said, “the state must establish a minimum of a one-year period of uninsurance for individuals” before they can receive public coverage.

That is considerably stricter than requirements imposed in the past. In February, for example, the Bush administration allowed Pennsylvania to increase its income limit to 300 percent of the poverty level after the state agreed to a six-month waiting period for children who are 2 and older with family incomes exceeding 200 percent of the poverty level.

As another precaution, Mr. Smith said, states wanting to cover children above 250 percent of the poverty level must show that “the number of children in the target population insured through private employers has not decreased by more than two percentage points over the prior five-year period.”

In New Jersey, which has a three-month waiting period, Ms. Kohler said, “we have no evidence of a decline in employer-sponsored coverage resulting from the Children’s Health Insurance Program.”

In the Senate debate this month, several Republicans offered a proposal similar to the new Bush administration policy. They wanted to require states to cover 95 percent of low-income children before allowing states to expand eligibility.

Senator Max Baucus, the Montana Democrat who is chairman of the Finance Committee, argued against the proposal, saying: “No state can meet 95 percent. No state currently meets 95 percent.”

Ms. Kohler estimated that New Jersey was covering 70 percent of eligible children.

In his letter, Mr. Smith said the new standards would apply to states that previously received federal approval to cover children with family incomes exceeding 250 percent of the poverty level. Such states should amend their state plans to meet federal expectations within 12 months, or the Bush administration “may pursue corrective action,” Mr. Smith said.

Two Republican senators, Charles E. Grassley of Iowa and Pat Roberts of Kansas, urged the Bush administration last week to deny New York’s request to cover children with family incomes up to four times the poverty level. The proposal, they said, violates the original intent of Congress, which wanted to focus on lower-income children.

But Gov. Eliot Spitzer of New York said that, “contrary to the senators’ objections,” federal law allows states to set higher income limits.

“Granting this expansion is essential to the health and well-being of New York’s children,” Mr. Spizter said.

 

[Roland00]

why should the government pay for health insurance when the kids already have health insurance through one of their parents? Why can't this money be spent where it is needed, or at least not add to the federal debt.

Yes other government spending needs to be cut, but entitlement spending is the fastest growth of all US spending. This is because entitlement spending is not controlled by congress unless they change the eligibility criteria, they are doing so with this recent two bills, instead of reauthorizing the old program they house and senate bills would vastly expand it.

The US needs less entitlement spending, it needs a more thorough safety net though. The government should only take care of you if you truly need help, if you don't need help responsibility should kick in. The safety net should be designed to get you back on your feat, act as a trampoline not as a permanent destination. Yes health insurance is expensive, congress should be focusing on ways to make it less expensive instead of increasing the size of entitlements and thus the national debt.

Two other news stories which give a fairer view of the issue, from both sides.
http://www.washingtonpost.com/wp-dyn/content/article/2007/08/20/AR2007082002159.html
http://www.washingtonpost.com/wp-dyn/content/article/2007/08/01/AR2007080100266.html?hpid=topnews%3EChildren's%20Health%20Bill%20Approved%20By%20House%3C/a%3E%3C/li%3E%20%3Cli%3E%3Ca%20href=

the recent house proposal would increase the number of people covered from 6.6 million by an additional 5 million for a total of 11 million.

 

[Roland00]

Whatever Alfie, I ain't going to play this game where there is only two choices, you are either with us or you are against us. The world isn't black or white, you can be critical of a policy while at the same time possessing smilar goals. You can disagree about the method of implementation. Then again I can understand why you can't see the difference, thinking your own thoughts is a hard ask for many individuals, blind allegiance and calling people names is so much easier.

You can continue your game of caricatures with other people who respond to you.

 

[jackoroe]

It isn't the governments job to provide health care or insurance for anybody. These fucktards spent a million dollars to mail a couple of washers to Iraq. They can't seem to manage to deliver water to New Orleans with any great success. And please don't tell us how much better your party would be at doing those things, because they suck just as badly.

Keep going down the socialized medicine path.

 

[RandomAccess]

why should the government pay for health insurance when the kids already have health insurance through one of their parents? Why can't this money be spent where it is needed, or at least not add to the federal debt.
-snip-

They do? Really? All of 'em? Is this one of those Republican "absolute" statements, one of those "black v. white" things that help them in their decision making process?

Let's try getting rid of the federal debt by firing Bush, ending the war in Iraq, and getting this country back on course! Bush's war screwed-up the budget, not liberal "entitlements."

 

[chance1]

I heard that Bush also steps on insects while walking - rather then avoiding them

and when he does he lets out a guttural sound

fucking guy

 

[LaloGS]

It's time to step on another bunch of insects. So much for Compassionate Conservatism. These goons are so concerned about their own pockets they can't see the suffering of poor children. They cut budgets for health care, education, school lunch programs, and allocate 30 billion over several years for entitlements, yet spend on average 12 billion a week on a war that has no other concern for them but to get their hands on the oil, and to line their pockets at the same time on the backs of suffering American children. Disgusting and reprehensible.

 

[smelter]

I heard that Bush also steps on insects while walking - rather then avoiding them

and when he does he lets out a guttural sound

fucking guy

Yeah I heard that too, Chance. I never posted it because I couldn't find a credible source .... I've always tried to be fair and balanced, so thanks for verifying it! May I quote this post in the future?

 

[Centexfarmer]

Is it even remotely possible to for anyone to stay on-topic in this forum, without launching into personal tirades?
</IMG>

 

[Roland00]

Alfie I ain't going to respond further to you anymore in this thread or other threads, I am putting you on ignore. You can call me yellow belly or whatever you want (you do this to all people who respond and tell you not to do so anyfurhter), I am just tired of your tirades.

to RandomAccess. According to the CBO from their study last year.
http://grassley.senate.gov/releases/2007/05102007.pdf

The Effect of SCHIP on Children’s
Health Insurance Coverage
SCHIP has significantly reduced the number of low income children who are uninsured. According to the Congressional Budget Office’s (CBO’s) analysis, among children living in families with income between 100 percent and 200 percent of the poverty level (the group with
the greatest increase in eligibility for public coverage under SCHIP), the uninsurance rate fell from 22.5 percent in 1996 (the year before SCHIP was enacted) to 16.9 percent in 2005, a reduction of 25 percent. In contrast, the uninsurance rate among higher-income children
remained relatively stable during that period. SCHIP has also apparently contributed to an increase in insurance coverage among children below the poverty level, as states’ outreach efforts and simplified enrollment procedures for SCHIP appear to have increased the percentage
of eligible children who participate in Medicaid.5

Although SCHIP has significantly reduced the number of uninsured children in low-income families, the net effect on the extent of coverage is smaller than the number of children who have been enrolled in public coverage as a result of SCHIP because the increase in public coverage
has been partially offset by a reduction in private coverage. 6 SCHIP provides an alternative source of coverage that is less expensive and that often provides a broader range of benefits than private insurance. As a result, some parents who otherwise would have enrolled their children
in private coverage may prefer instead to switch their coverage to SCHIP.7 In addition, to the extent that SCHIP makes private coverage less important for some low income families, parents might be more inclined to take jobs that offer higher cash wages rather than health insurance.
Moreover, if employers of low-wage workers believe that SCHIP reduces the value of private health insurance in attracting employees, some might reduce their contribution to the premiums for family coverage, reduce the benefits offered, stop offering family coverage, or stop offering insurance altogether.

Considerable potential thus exists for increases in SCHIP coverage to be partially offset by a reduction in private coverage. For example, about 60 percent of the children who were eligible for the program were covered by private insurance in the year before the program was enacted.8
But measuring the extent to which enrollment in SCHIP has actually been offset by a reduction in private coverage is difficult. Estimates vary depending on the measure that is used. Moreover, studies have obtained widely varying estimates depending on the data sources and methods
used.

On the basis of a review of the research literature, CBO concludes that the most reliable estimates currently available suggest that the reduction in private coverage among children is between a quarter and a half of the increase in public coverage resulting from SCHIP. In other words, for every 100 children who enroll as a result of SCHIP, there is a corresponding reduction in private coverage of between 25 and 50 children.9 The available evidence,
which is quite limited, suggests that the bulk of the reduction in private coverage occurs because parents choose to forgo private coverage and enroll their children in SCHIP (because of better benefits, lower costs, or some combination thereof ), rather than employers deciding to drop coverage for such children. No studies have estimated the extent to which SCHIP reduces private
coverage among parents, so the available estimates probably understate the total reduction in private coverage associated with the introduction of SCHIP.

Changes to the program may generate different effects on private coverage than those estimates suggest; in general, expanding the program to children in higher-income families is likely to generate more of an offsetting reduction in private coverage (and therefore less of a net reduction
in uninsurance) than expanding the program to more children in low-income families. (Over the course of 2005, an average of nearly 2 million children were apparently eligible for SCHIP but remained uninsured.) 10 As discussed below, policymakers are exploring options to increase participation among eligible children.

The link goes on and has the CBO all about SCHIP including its design and possible changes congress can do while reauthorizing it.

That 25 to 50% of children who had private health insurance but dropped it due to SCHIP is under the current criteria. The ones which set the children's parents income from 200 to 250% above the federal poverty line (which translates to about 40k for a family of 4). 25 to 50% for the current guidelines. Remember the CBO also said this

in general, expanding the program to children in higher-income families is likely to generate more of an offsetting reduction in private coverage (and therefore less of a net reduction
in uninsurance) than expanding the program to more children in low-income families."

In my mind 25 to 50% of kids dropping for public health insurance still make this a good program for the opposite 50 to 75% of kids now get health insurance. I am okay with a minor free rider effect. But expand the program to 400% above the poverty line and there will be a much large amount of people who drop their kids on their private insurance to get SCHIP.

Seriously if the goverment is going to provide health insurance, why shouldn't it be mean tested? This applies not just to SCHIP but also to medicare. If you are wealthy you should foot part of the bill and not just rely on the government. This money would be better spent on other areas including increasing the coverage of the already existing SCHIP people. Give better coverage to the kids whose parents make under 30k, instead of giving access to kids whose parents make almost 90k and who can easily afford health insurance. Or better yet according to the CBO 2 million people were eligible for this program under the old guidelines, also didn't possess any insurance, but did not take advantage of the program. Why don't we use this money to start an education program telling parents they have access to it. Lets get those 2 million covered whose parents are too poor to get health insurance before we extend the criteria all the way up to 400% above the poverty line. (which is about 80k).

SCHIP is a good program as is, it is effective serves a desperate need without becoming too expensive and wasteful. Lets not change this.

 

[naked gent]

Roland thanks for the info. You shed some light on an issue where others only increase the heat.

The program was designed to help low income people get health insurance. Once we get to 4 times the poverty level I'm not sure we're still talking about low income people.

It makes sense for the state to cover those children who cannot afford health insurance because the state will be picking up the bill should they get sick so all we're really talking about is the most economical way to do it and doing it before they get sick is cheaper.

However, once the state includes those who already have health insurance that reasoning no longer is valid. To those who support the expansion of the program to include those at 4 times the poverty level I'd like to ask how much higher would you go?

If you're willing to provide coverage for a family of 4 making 80,000 a yr are you also willing to provide coverage for a family of 4 making 120,000 a yr.....or 160,000?

At what level would you say its up to the parents and not the public?

And lance while its easy to say Bush is in the pockets of the insurance companies can you pause for a minute and think about what this means.

If we insure those kids publically we'll have to pay for it with tax dollars and since we're removing from the private insurance pool a group of mostly healthy young people the private insurance rates will probably go up as the remaining group has a higher percentage of sick people than it did before.

A smaller pool with more sick people means higher rates.

So we'll be paying more in taxes and higher private insurance rates. Thats the policy you support in your desire to demonize Bush.

If those are the policies we can expect from democrats should they control both branches of goverment they won't be getting my vote.

 

[Just_Believe18]

The problem is more "middle-class income" families are unable to pay for private health care. My family's healthcare coverage surged 28% more a year through Kaiser. Did my family's income rise 28% to cover those costs and other inflation? Ha!

The Federal poverty line is a joke. Most states allow coverage for families that are up to 250% over the poverty line. If anyone actually lived the federal poverty line, they would be in a homeless shelter eating canned beans. The federal government and the Bush Administration is so clueless about poverty. They think it's "entitlement" when they lack the understanding that chronic healthcare problems created by a lack of preventative care is more costly by the billions.

 

[Roland00]

The problem is more "middle-class income" families are unable to pay for private health care. My family's healthcare coverage surged 28% more a year through Kaiser. Did my family's income rise 28% to cover those costs and other inflation? Ha!

The Federal poverty line is a joke. Most states allow coverage for families that are up to 250% over the poverty line. If anyone actually lived the federal poverty line, they would be in a homeless shelter eating canned beans. The federal government and the Bush Administration is so clueless about poverty. They think it's "entitlement" when they lack the understanding that chronic healthcare problems created by a lack of preventative care is more costly by the billions.

No it is called an entitlement program not because of house useful it is, but because that congress can't remove funding directly (like they can for other departments including the department of defense). They can only change the requirements and thus who is eligible for the program. Once eligible for the program though congress has to pass out the dough.

The legal definition of entitlement

ENTITLEMENT SPENDING refers to funds for programs like Medicare/Medicaid, Social Security, & veterans' benefits. Funding levels are automatically set by the number of eligible recipients, not at the discretion of Congress.

Each person eligible for benefits by law receives them unless Congress changes the eligibility criteria. Entitlement payments represent the largest portion of the federal budget.

http://www.c-span.org/guide/congress/glossary/entitle.htm

ENTITLEMENT PROGRAM - A federal program that guarantees a certain level of benefits to persons or other entities who meet requirements set by law, such as Social Security, farm price supports or unemployment benefits. It thus leaves no discretion with Congress on how much money to appropriate, and some entitlements carry permanent appropriations.

http://www.lectlaw.com/def/e081.htm

Yes 200% above the federal poverty line is not enough for most people to afford health insurance, it is the 200-300% range where people can start affording it, and the higher up you go the better the insurance gets.

Instead increasing the people covered up to 400% of the federal poverty line, lets increase the benefits of those who already qualify, add those 2 million who qualify but haven't enrolled due to ignorance or not wanting the program, do a matching contributing with private insurance (okay you don't need to drop your private insurance instead for every dollar the insurance company pays the feds/states will match a dollar), or if congress is too brained dead to figure out how to help the truely in need people pay down the debt or spend it in some other way (like increase the child tax credit).

 

[maxpowr9]

The problem is more "middle-class income" families are unable to pay for private health care. My family's healthcare coverage surged 28% more a year through Kaiser. Did my family's income rise 28% to cover those costs and other inflation? Ha!

This is exactly what is happening in MA. Since all MA citizens are now required to have health insurance, all the insurance companies have jacked up the price. My mom surely has not made 18% more then last year. I understand that "universal" healthcare is mostly aimed at lower class families, however, it is the middle class, those that just have enough to get by, that is taking the biggest hit financially. Reckon middle class in MA is an adult that makes about 38k a year (it would be wrong for me not to admit that MA has one of the highest standards of living in the US). Not to mention MA has some of the best medical facilities in the world.