The Wrong Direction On Kids' Health Care

n a recent federal rule change, the Bush administration has proved that it is not only stingy about covering uninsured children, but that it is committed to undermining any effort to expand the State Children's Health Insurance Program.

It has long been known that President Bush and other fiscal conservatives are not in favor of expanded funding for SCHIP. The $30 billion over five years that President Bush has proposed for reauthorization is not enough to even sustain the current program. Fortunately, Democrats and Republicans in Congress have joined forces to fight this proposal and ensure at least $60 billion is allocated in their reauthorization bills.

Now, facing failure in Congress, the Bush administration has resorted to a new administrative policy that essentially prohibits states from taking their own initiative to expand coverage beyond 250 percent of the federal poverty level. According to the new rule, if states want to receive a federal waiver to cover children whose families earn more than 250 percent of the federal poverty level, they will have to show that 95 percent of children under 200 percent of the federal poverty level are covered, a rate that hasn't been achieved in any state.

The goal of expanding coverage to more already eligible kids is laudable, but the administration's approach is severely misguided. With about 6 million uninsured kids who are already eligible for state health insurance nationally, a simple administrative order without any additional funding or policy change is not sufficient. In fact, some of the other burdensome requirements in the new policy, such as requiring that children are uninsured for more than a year before they are eligible for SCHIP, may actually decrease enrollment among otherwise qualified but unenrolled children.

Unfortunately, the new federal requirements will have a disproportionate effect on Connecticut, which enrolls children in families with incomes greater than 250 percent of the federal poverty level. Seventeen other states and the District of Columbia enroll such children or recently passed legislation to do so. Not only will recent state efforts to expand coverage be jeopardized, but so will coverage for thousands of children who are already in the program.

In a state like Connecticut with one of the highest costs of living in the country, 250 percent of the federal poverty ($41,500 for a family of three) doesn't go very far. With the rising cost of health insurance it can be expected that most of the families that lose coverage will be unable to afford any alternative health insurance. Connecticut citizens will have to then pay for their care should they develop medical problems and end up in the emergency room.

Unfortunately, because the federal rule changes supersede state law, Connecticut citizens won't be able to do much about it.

If President Bush really wants to refocus SCHIP on its original intentions, he should instead take a closer look at the legislation that he plans to veto. Of the 4 million children expected to be covered in the Senate bill, as many as 85 percent are already eligible for SCHIP or Medicaid but are just not enrolled. Moreover, the estimated "crowd out effect," the percent of families who would switch from private insurance to public insurance, is less than half of what was estimated for the tax-based health insurance proposals that President Bush submitted last year, according to MIT economist Jonathan Gruber.

Perhaps the most innovative component of the Senate and House bills are incentives for states to try out new ways to cut bureaucratic barriers and use existing information to automatically enroll eligible children. By cutting unneeded bureaucracy, the government can reduce administrative costs, reach more children and focus more resources on actually providing care.

President Bush even promised at the Republican National Convention in 2004 that "In a new term, we will lead an aggressive effort to enroll millions of poor children who are eligible but not signed up for the government's health insurance programs." Now it's time to get beyond the ideology of big government and small government and focus instead on providing some good government in the interest of America's children.

Author

Robert Nelb, 21, is a senior at Yale University in an accelerated master's of public health degree program, a senior fellow at the Roosevelt Institution (www. rooseveltinstitution.org) and a health care advocate for the Connecticut Health Policy Project.