The New York Times has a front page story revealing new rules from the Bush Administration that would restrict access to the SCHIP program – which insures children in the absence of private coverage--the program Congressional Democrats are seeking to expand, while Bush is threatening to veto the bills. This is another example of Bush using executive power to kill popular legislation- and he did it when Congress was in recess, natch, in hopes no one would notice, I guess.

The new rules could result in making ineligible for coverage some children who are currently covered, while making it impossible for further expansions of the program.

At the Nation, Ben Crair sums it up well:

When President Bush declares his "support" for the "initial intent" of SCHIP, one wonders what exactly he imagines that to be. Originally, he proposed to fund the program at such low levels that it would actually have resulted in more uninsured children. Now that Congress has shown its determination to flout that request--both houses have voted to fund the program much more generously--he seems intent on starving the program by using his executive authority to limit the states' ability to expand it.

When SCHIP was first created, states typically restricted eligibility to families making less than 200 percent of the federal poverty level. Since then, however, several states have increased that cap to 300 percent (and even 350 percent in the case of New Jersey). Now, according to The New York Times, Bush has announced new standards intended to stymie state efforts to expand eligibility. These standards, which HHS would enforce, include a provision requiring states to demonstrate that they have insured at least 95 percent of those children living below 200 percent of the poverty level before they can receive federal funding to insure children living above 250 percent--a benchmark the states say will be impossible to hurdle.

States that will lose under Bush's plan: here .

According to the NY Times, the Bush Administration is using the Congress’ recess to impose impossible demands on state health systems with the interest of limited children’s enrollment in SCHIP. The NY Times article is here:

In a memo, sent to state health officials about 7:30 p.m. on Friday, Dennis G. Smith, the director of the federal Center for Medicaid and State Operations, set a high standard for states that want to raise eligibility for the child health program above 250 percent of the poverty level.

To minimize the risk of such substitution, Mr. Smith said in his letter, states should charge co-payments or premiums that approximate the cost of private coverage and should impose “waiting periods,” to make sure higher-income children do not go directly from a private health plan to a public program.

If a state wants to set its income limit above 250 percent of the poverty level ($51,625 for a family of four), Mr. Smith said, “the state must establish a minimum of a one-year period of uninsurance for individuals” before they can receive public coverage.

The poverty level for a family of four is $20,650 in annual income. New York now covers children in families with income up to 250 percent of the poverty level. The State Legislature has passed a bill that would raise the limit to 400 percent of the poverty level — $82,600 for a family of four — but the change is subject to federal approval.

California wants to increase its income limit to 300 percent of the poverty level, from 250 percent. Pennsylvania recently raised its limit to 300 percent, from 200 percent. New Jersey has had a limit of 350 percent for more than five years.

As on other issues like immigration, the White House is taking action on its own to advance policies that were not embraced by Congress.

So the Bush spin on children's health insurance is: SCHIP was meant for poor families. Now, families who aren’t poor enough are using this program. That’s cheating. They should have private insurance and not mooch off the Government.

The truth is this: health insurance is too expensive for too many Americans. Kids need health insurance. The Government can help provide this with minimal pain to the American people.

BTW: What is the federal poverty level? It’s the “estimate of the income necessary to purchase what society defines as a minimally acceptable standard of living; classification is based on the poverty index originated by the Social Security Administration in 1964 (revised in 1969 and 1980). In 2002 a family of four with income less than $18,100 lived below the poverty level” See NYTimes.

I like Gene Sperling’s analysis of Bush’s action, hat tip to the Next Hurrah :

What is most inexcusable about the White House stance is what they don't say. They offer nothing -- no better idea, no alternative, no plan -- that has been shown to keep even a chunk of these 5 million to 6 million children from going to sleep every night without health insurance.

They are content to keep the status quo even with heartbreaking reports that uninsured infants with congenital heart problems are 10 times more likely to die because of delayed treatment than those with coverage.

Before, "compassionate conservatism" may have seemed like a political bumper sticker. Now it seems like the punch line of a sad joke, at the expense of millions of impoverished children.

Firedoglake has a great post here:

In the meantime, recognizing that SCHIP works, both Republican and Democratic Governors have expanded eligibility rules, so that families with incomes higher that the US poverty level of $20,600 per year could qualify. But the Bush Administration now seeks to impose strict limits on the states’ ability to expand eligibility, forcing the states to meet impossible hurdles before they can cover more children. Under the new rules, states would have to:

- Prove that 95 percent of those eligible at the 200 percent of the poverty level are covered before allowing kids in families at 250 percent of the poverty level to be covered. State officials all agree this standard cannot be met, which means the state would not only be prohibited from expanding eligibility to more children in the future but also have to scale back current expanded eligibility rules. In other words, children above the poverty line and currently covered by SCHIP could be removed from the program because the state can’t meet the condition for covering them.

- Demonstrate that raising the eligibility standard would not result in a reduction in private insurance. In other words, states can’t expand public coverage except by protecting the private insurance market share.

- Require that children who receive care under SCHIP pay deductibles set high enough to make the private insurance coverage “competitive.” Translation: arbitrarily impose additional costs on families using the public system so that the private system looks more attractive in comparison, even though the aggregate effect is to raise total costs for covering the same number of children, with no guarantee that those facing higher SCHIP deductibles would actually seek private insurance instead of just foregoing health care they can no longer afford.

The Bush Administration and its Republican Congressional allies seek to justify this latest outrage by claiming that SCHIP was meant only to help those children at or below the poverty line. That may have been its original rationale, but so what? There is no public policy reason to limit a children’s health care system that is highly successful, improves public health, is endorsed by governors of both parties, and costs less than private insurance schemes that don’t work as well (because of the perverse incentives private insurance schemes have to deny or limit coverage to lower their costs and increase profits). Nor is there even a “conservative” policy justification for subsidizing a private insurance scheme merely for the purpose of making it appear “competitive,” when in fact it is more costly (as well as less effective in providing actual care). That’s phony competition, subsidized by tax payers, and even Republicans should oppose that.

OK, so George Bush is blatantly choosing to protect health insurance companies over America’s children.

As Emily McKhann writes on the Motherhood , "Once again, I'm just sickened by this Administration." Me too. What can we do?

1) Read this excellent post on Universal Health blog, where there is excellent health activism advice, especially:

* Write letters to the editor of your local newspaper explaining the Bush and Republican attack on Americans’ health.
* Blog about health issues, and how your health is being affected.

Take this advice from Pam Mandel : 1) Listen, if this is an issue you really care about, I would suggest you get on the phone right now with your reps. Because (my politics here) as much as we may like to agree that "this is one veto fight we can win", I'd like to point you to the recent shameful failure of Congress to prevent the wiretapping bill from going through. Personally I don't trust that we can rely on this Congress to act without massive public outrage.

Are you still reading this? Must be coz you're not sure how to contact your reps.

House: http://www.house.gov/writerep/
Congress: http://www.senate.gov/general/contact_information/senators_cfm.cfm

2) If you’re a healthcare voter, look carefully at what each candidate says about SCHIP. As Maria Niles noted, “During the Republican debate on ABC every candidate said that they don't support the SCHIP expansion bill that Bush has announced he will veto. Here is pertinent video from the debate:

http://www.kaisernetwork.org/health_cast/health2008hc.cfm?&hc=2269

John Edwards talked about this last week in Iowa:

http://youtube.com/watch?v=y1iAc_PuWNI
He said if the president vetoes the bill, Congress should override his veto.

Hillary Clinton helped create SCHIP http://www.kaisernetwork.org/daily_reports/health2008dr.cfm?DR_ID=46980 but we also know she is not anti-lobbyist- so how a position on SCHIP expansion shake out with private health insurance companies?

For more on the legislative process behind SCHIP reauthorization: http://www.kaisernetwork.org/daily_reports/health2008dr.cfm?DR_ID=46636

3) Support MomsRising and Children’s Defense Fund .