The Next Big Health Care Battle

The New York Times | Editorial

Monday 12 March 2007

At a time when the nation is pondering how to provide medical coverage to some 47 million uninsured Americans, it is logical and right to start with the country's nine million uninsured children. The Bush administration, unfortunately, is going in exactly the opposite direction.

In a shortsighted effort to save money and promote its free-market philosophy, it has proposed reducing the federal contribution to a highly successful children's health insurance program operated by the states. Democratic leaders in Congress are planning to respond with bold, and necessary, proposals to cover a large chunk of the nine million uninsured children - at a cost that could reach $50 billion to $60 billion over five years.

That price tag might seem staggering when health care costs are already spiraling out of control, but less so when one considers that the administration is pouring $200 billion a year into a losing war in Iraq. Just eliminating the large overpayments granted to private health plans that participate in Medicare would save $65 billion over five years. According to a recent New York Times/CBS News poll a majority of Americans believe that the federal government should guarantee health insurance to all Americans, especially children, and are willing to pay higher taxes to finance it.

The issue is coming to a head because the highly successful State Children's Health Insurance Program, or S-Chip, is up for reauthorization. The program is a joint federal-state effort to cover children whose family income is too high to qualify for Medicaid - the primary federal-state program to cover the poor - but too low to pay for private coverage.

States vary widely in how they handle S-Chip. Many programs cover children in families earning well above the federal poverty level, and sometimes coverage is provided for parents or other adults. Now the Bush administration wants to focus primarily on children from families earning no more than twice the poverty level, or $41,300 for a family of four, while reducing the federal matching rate for everyone else. (A typical family policy can easily cost more than $10,000 a year.) The states would have to take up the slack or watch an estimated 400,000 children - some predict many more than that - fall off the rolls.

What Americans want and what the country needs is to protect more - not fewer - children. Congressional Democrats propose to do that using both S-Chip and the far larger Medicaid program. Some six million of the nine million uninsured children are actually eligible for one program or the other but are not enrolled, because their families either do not know they are eligible or are discouraged by a complicated bureaucratic process. All efforts should be made to enroll them.

The administration prefers to rely on tax subsidies to encourage more people to buy their own health insurance and is encouraging states to redirect federal funds they already receive for health care to subsidize health ins'rance for the poor. Medicaid and S-Chip have been remarkably effective in reducing the number of uninsured children while the number of uninsured adults keeps increasing. That is a success worth building on, not diminishing.

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