By KEVIN FREKING, Associated Press Writer
December 26, 2007
WASHINGTON - The modest spending increase that Congress approved
for a popular children's health insurance program will maintain
coverage for those already enrolled. But many lacking insurance
will have to look elsewhere.
Few expected such a result when 2007 began. Democrats proposed
a huge spending increase on the federal-state partnership known
as the State Children's Health Insurance Program. Many Republicans
embraced the idea. Meanwhile, states all over the country were
drawing up plans to expand health coverage.
A lot of those plans have been scuttled. The spending increase
most lawmakers supported has been vetoed twice by President
Bush, who balked at the $35 billion price tag and method of
payment a tobacco tax.
"We were all very, very hopeful. Now, we feel like they
are farther apart than they were a year ago," said Cindi
Jones, who oversees Virginia's SCHIP program.
Virginia was one of several states going into the year thinking
about expanding eligibility limits for SCHIP. It's a typical
state in that it provides health coverage for families with
incomes up to twice the federal poverty level $34,340 for a
family of three. Jones said officials considered moving the
eligibility limit to at least $42,925.
"This just didn't seem like the right time to raise the
eligibility with the uncertainty of what's going on at the
federal level," Jones said.
Lawmakers across the state line in West Virginia approved
an expansion that would have raised the eligibility level to
$51,510 for a family of three. It's now at $37,774. The increase
would have led to about 4,000 more children getting coverage.
"That potential growth is on hold," said Sharon
L. Carte, who oversees West Virginia's program.
Some analysts say the number of children getting SCHIP coverage
may still decline next year a bitter prospect for Democrats
who promised they would expand enrollment from 6 million children
to 10 million.
"We are left with a package that addresses the most immediate
concerns, but leaves any real health care improvements for
another day," Rep. Frank Pallone, D-N.J., said during
last week's SCHIP debate. "I think that is very unfortunate."
Republican lawmakers say they want to work out a compromise.
But many are satisfied with the extension the House approved
Wednesday. Republican leader John Boehner, R-Ohio, said the
extension "provides all the resources necessary to cover
low-income children who need quality health insurance."
Republicans say any expansion should not allow middle-income
families to drop private coverage for the public kind. They
insisted that SCHIP retain a new Bush administration directive
that makes it harder for states to cover middle-income children.
Democrats criticized the directive for months. They promised
to rescind it, but failed.
The directive said that before states cover higher-income
children, they must meet the following threshold: At least
95 percent of children eligible for Medicaid and SCHIP with
incomes less than twice the poverty level must be enrolled
in those programs.
Many states say meeting that threshold is nearly impossible.
But that's not all the directive said. Even if states meet
that threshold, the middle-income children will have to go
without private coverage for a full year before they can enroll
in SCHIP, and their families will have to pay premiums or co-payments
that are 5 percent of their income.
The directive will affect about half the states. Fourteen
are already covering children above $42,925 for a family of
three and 10 more were planning to do so, says the Center for
Children and Families at Georgetown University.
One of those states, California, is considering a proposal
that would require all Californians to have health insurance
coverage, but a central piece of that proposal also increases
the threshold for SCHIP eligibility from the $42,925 level
for a family of three to the $51,510 level.
Cindy Mann, the center's executive director, said she believes
the administration's directive means fewer children will get
health coverage through SCHIP next year.
"It's definitely a step backward from where we started
in 2007," Mann said. "We would have seen growth in
the program. We're not going to see that growth, and by August,
we'll start to see a ratcheting down."
Overall, about 9.4 million children ages 18 and under are
uninsured, according to the Census Bureau.
Bush administration officials say the directive will require
states to do the hard work of finding and enrolling poor kids
before they move on to less needy families. Health and Human
Services Secretary Mike Leavitt said the administration believes
the government has a role in providing health coverage to the
elderly, poor and disabled.
"The SCHIP question was: Who do we consider to be in
that category," Leavitt said.
Lawmakers from both parties say that when they return in January,
they will try to work out a compromise on SCHIP. Differences
over who should get coverage have clearly narrowed over the
past months. But differences over how to pay for expansion
remain considerable.
The president has said a tax increase is a deal-breaker. Democrats,
meanwhile, say the same thing about cutting Medicaid and Medicare.
"We'll certainly reach out, but it's going to be hard
because they do challenge the basic premise that there are
these additional kids that need to be covered," Pallone
said. "And they don't seem to want to come up with a way
to pay for the coverage."
The administration says the president recommended $96 billion
in spending reductions in his last budget. Lawmakers can choose
from that list.
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