Monday, August 27, 2007

BOB HERBERT: Holding Kids Hostage

The governors of New York and New Jersey were upset and not trying to hide it.

“We had zero forewarning,” said New Jersey’s Jon Corzine. “It was sprung at 7:30 on a Friday night in the middle of August, the time when it would draw the least fire.”

He was talking about the Bush administration’s latest effort to thwart the expansion of the popular Children’s Health Insurance Program. Governors in several states are trying to include more youngsters from the lower rungs of the middle class and have vowed to fight the president on this issue.

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.

“It’s stunning,” said New York’s Gov. Eliot Spitzer. “He says he’s going to veto health care for kids because it’s too expensive at the same time that these continuing resolutions for the war, where we don’t even know what the cost is, are going through unabated. This is insanity.

“Everybody agrees this is the right thing to do except the Bush administration.”

Health coverage for poor children is provided by Medicaid. CHIP was originally designed to cover the children of the working poor. That has worked well, but there are still huge numbers of families who need help.

“The reality,” said Governor Spitzer, “is that there is an enormous proportion of American society above the poverty level but in the lower middle class that simply can’t afford health coverage.”

Wherever there are large numbers of families without coverage, you will find children who are suffering needlessly and, in extreme cases, dying. They don’t get the preventive care or the attention to chronic illness that they should.

“That has not only an immediate effect on their development,” said Mr. Spitzer, “but a long-term cost to society that is incalculable.”

Several states, including New York and New Jersey, have used federal waivers to raise the family income ceiling for eligibility to participate in CHIP. New Jersey, for example, offers coverage to the children of families with incomes as high as 350 percent of the official poverty rate for a family of four, which is $20,650 a year. New York has an upper limit of 250 percent of the poverty rate and is trying to raise it to 400 percent.

State officials said the onerous new rules would make it all but impossible to offer coverage beyond 250 percent of the poverty level.

Administration officials have argued that the CHIP program should adhere closely to its original intent of limiting coverage to families only slightly above the official poverty line. They said there is a danger that families with higher incomes would begin substituting CHIP for private insurance coverage.

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.

Denying CHIP to such families forces them to seek out hospital emergency rooms when medical treatment can no longer be postponed. “I see it every day,” said Governor Corzine. “If you’re uninsured, particularly with children, if you don’t have a place to go, that’s where people show up.”

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.

Ronald Reagan, one of the tribunes in the fight against Medicare and Medicaid back in the ’60s, pumped up the warnings against “socialized medicine” by saying that if Medicare becomes a reality “you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”

I wonder what crazy things the ideologues think would happen if CHIP is expanded to cover the children who have no health insurance today.

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