How the Grinch Stole Columbus Day: SCHIP and the Battle over Children?s Health Coverage

On October 3, President Bush vetoed H.R. 976, the bipartisan bill passed by both the House and Senate that would have expanded The State Children’s Health Insurance Program (SCHIP) by $35 billion over the next five years.

SCHIP is a shared federal-state program that subsidizes health insurance coverage for more than six and a half million Americans, most of them children who live in households with combined incomes less than 200 percent of the federal poverty level (FPL) guidelines (currently $41,300). The recent congressional expansion bill, funded by a 61 cent hike in the federal cigarette tax, sought to extend insurance coverage to an additional four million children by 2012.

So what’s the rumpus? In short: numbers.

President Bush’s plan would increase SCHIP by five billion dollars over the next five years; the House bill sought a $50 billion boost, later reduced to $35 billion in line with the Senate measure.

• Mr. Bush wants to cap SCHIP eligibility at 200 percent of FPL; the congressional bill would have increased limits to 300 percent of FPL (about $62,000 for a family of four) on a state by state basis, pending federal administrative approval.
• In the Senate, 18 Republicans sided with their Democrat colleagues—a margin large enough to overturn the presidential veto. In the House, however, the bill’s supporters still lack between 18 and 24 votes (depending on estimates) to reverse Mr. Bush’s big red X.
• The battle in the House to override Mr. Bush’s veto was tabled for 15 days until the Senate returns from recess, offering time for the bill’s supporters to swing votes in their direction and providing two weeks of what is sure to be acerbic criticism from 2008 democratic presidential hopefuls who are busy publicizing their own healthcare initiatives.
• According to the Bush administration and some republican opponents of the bill, the expansion effort vetoed by the President yesterday could unwittingly extend SCHIP coverage to families of four earning up to $83,000 per year (“That doesn’t sound poor to me,” Bush said in a speech following the veto.). The bill’s proponents dispute that claim, and an Urban Institute study showing that “between 78 and 85 percent of the 4 to 5 million uninsured children who stand to gain coverage under the bills [then in the House and Senate] have incomes below 200 percent of the FPL.” No word on how Mr. Bush benchmarks his definition of “poor.”

But all this commotion also concerns words.

Phantasmagoric phrases like “socialized medicine,” “government healthcare,” and “the medical welfare state,” are rising from the dead like so many Halloween-themed metaphors this month.

In play here as well is the continually growing sentiment that the President is out of step with the rest of the country concerning issues of central importance to most Americans. In a speech in Pennsylvania following the veto, Mr. Bush referred to under- and uninsured American children as “the poor children,” (oh… those people) and suggested his hypothetical willingness to compromise on SCHIP with “a little more money” (ah ha: so that’s what a $30 billion discrepancy looks like).

Despite the upwelling of political rhetoric that is sure to surround debate on SCHIP between now and the end of the year, the expansion of the decade-old program is the right thing to do: for healthcare providers, for American consumers, and even for the ARM industry.

To follow just one example, a recent joint study by Arizona State and Brigham Young University researchers concluded that funding shortfalls for SCHIP that led to disenrollment from the program would have effects on communities that could be both economically quantified and more broadly felt in marked increases in emergency care admissions for routine medical needs. Not only would this shift exacerbate emergency room overcrowding and the availability of inpatient bed space, but the non-discounted cost of emergency care will place additional strain on low-income healthcare consumers who already vex hospital systems’ revenue cycle management departments.

Children get sick; that’s what they do. If SCHIP does not expand its coverage in lieu of a better alternative, hospitals’ bad debt will continue to rise, and healthcare providers’ partners in the recovery of delinquent accounts—collection agencies—will be forced not only to pursue consumers who in many cases admittedly cannot pay, but now might be seen in the public relations arena as simultaneously victims of sickness and of the State. Think headline risk, writ large.

Mr. Bush is either anesthetized to, or has come to fully embrace, his full-fledged status as a lame duck president. Ironically, given an ARM industry context, the term “lame duck” is derived from an 18th century British moniker for a London broker who defaulted on his debts. But it is perhaps the timing of the veto of H.R. 976 that has reduced the President from lame duck to virtual foie gras.

On the one hand, congressional legislators—both Democrat and Republican (after all, even Senator Orrin Hatch, R-Utah, got behind the SCHIP expansion)—might be seen as the Charlie Trotters of the U.S. government, in his refusal to serve the fatty French delicacy on the grounds that its production was inhumane (and which led, in part, to a 2006 Chicago ban on the sale of foie gras in Windy City restaurants). More likely, however, the populist sentiment epitomized by the pedestrian, fast-food fumblings of TV short order cook Rachel Ray better represents the American body politic on Mr. Bush’s SCHIP stance.

Food is not moral, Mr. President. So go ahead, offer yourself up as foie gras. But the People intrinsically know that Braunschweiger is much more palatable, much more affordable, much more… them.