Cutting kids’ health insurance, illegally
Remember the Republican Contract With America? President George W. Bush apparently didn’t when he cut eligibility for children’s health insurance last fall.
Mr. Bush acted unilaterally to change rules of the popular State Children’s Health Insurance Program, known as SCHIP. He cut eligibility for about 17,000 Missouri kids and hundreds of thousands in Illinois.
Mr. Bush made the changes as Congress was gearing up to expand SCHIP, which is designed to cover children in families that earn too much to qualify for Medicaid but not enough to buy insurance on their own. The changes took everyone by surprise — states, that administer SCHIP and have traditionally set its eligibility levels; and Congress, which voted twice last year to renew and expand the program. The administration insisted at the time, and continues to insist now, that it has authority to make the changes.
But the Government Accountability Office ruled differently last week. One of the first things Republicans did when they took control of the House of Representatives in 1994 was to limit the executive branch’s rule-making ability. It was part of former Speaker Newt Gingrich’s Contract with America, which thwarted environmental and health rules that were opposed by industry and insurance interests. Under a Republican-sponsored law, administrative rule changes cannot go into effect until they had been submitted to both houses of Congress and to the Comptroller General. Mr. Bush did neither.
As Congress debated SCHIP expansion, Mr. Bush took his usual my-way-or-the-highway approach. He exercised a rare veto, not once but twice, to kill expansion bills that had been overwhelmingly approved by both the House and Senate. Now, he’s going to have to submit his proposed rule changes for Congressional approval. With a simple majority, Congress can postpone the date those rules go into effect by 12 months — three months longer than Mr. Bush’s remaining time in office.
If health care for children weren’t at stake, it would be comic to see how a president who is so famously allergic to regulation has run afoul of his own party’s successful anti-regulatory rhetoric. Mr. Gingrich, who has re-invented himself as a health care consultant since being voted out of office, has perhaps inadvertently done children of working poor families a great service.
John G. Carlton is an editorial writer who covers health care, science, the environment and public utilities. Before joining the editorial page, "Doc" was the newspaper's medical writer for four years. He has also worked at newspapers in Connecticut and New York. He's fond of heavy sarcasm and light anti-tank weapons. He lives in west St. Louis County with his wife, Martha Madigan, their daughter Ana and an overly enthusiastic Australian Shepherd dog, Savannah. 
If the education of the public were not at stake, this article would be a joke… and a sad one at that.
This letter from the GAO did nothing that you would have people believe it would do. Not one child will now get free government healthcare because of it.
Further, the “rule” you so hotly debate said only that the states would need to certify 95% coverage of those under 250% of the poverty level before that state could (get funding) to cover more… people making more.
Thus in fact cutting no one off. 41 states have already complied.
These facts, as they exist took all of 10 minutes for me, a bitter old fat white man to find. I can only ASSUME that had you wished to know, you could have found them much easier.
To the surprise of no one your agenda is clear.
Bitter?
Did someone say Bitter?
Call the media!
I have to correct your facts, tsquare.
At the time Mr. Bush wrote the new rule, 10 states including Missouri and Illinois were already covering children from families earning more than 250 percent of poverty. Another 14 had authorized expansions above that figure. Several are now suing the administration in federal court to win permission to go ahead with the expansion plan. Your assertion that 41 states have “already complied” is inaccurate.
The rule change required states to certify that they already cover 95 percent of eligible children at lower income levels. Since the number of eligible children is based on a population estimate, and success is entirely dependent on factors outside of its control (the willingness of parents — including homeless families and those in unstable housing situations — to enroll healthy children) no state has come close to reaching that benchmark.
The impact of that rule change, then, was to eliminate eligibility for about 17,000 Missouri children who were covered by our state’s SCHIP program, and hundreds of thousands of others who were covered in Illinois. Those were children with parents who enrolled them in the program. They were getting coverage before the Bush administration rule change. They would have lost it when the rule change went into effect. To argue that they didn’t lose that coverage as a result of the rule change seems disingenuous.
Doesn’t a program ostensibly aimed at the poor but covers children from families making 250% over the poverty limit seem a little odd? I would hate to find out that truly eligible people are being left out because the funds were used on people who can quite easily pay for their own care.
The president’s two vetos were well deserved. Democrats wanted to define a child as an adult aged 25. They also failed to provide any method of asset testing. One of the poster families for subsidized health care trotted out by Harry Reid and Nancy Pelosi last summer were successful business owners, owned a large home outright, and drove 2 new vehicles. Must suck to be that poor.
Mr. Carlton:
I only know what I read from the GAO
http://www.gao.gov/decisions/other/316048.pdf
“On August 17, 2007, CMS issued a letter to state health officials (SHO #07-001) for the stated purpose of clarifying how CMS “applies existing statutory and regulatory requirements” for states that want to extend coverage under their SCHIP programs to children in families with effective family incomes above 250 percent of the federal poverty level (FPL). Specifically, the letter indicates that it is “clarifying that the reasonable procedures adopted by States to prevent crowd-out pursuant to 42 C.F.R. 457.805 should include . . . five general crowd-out strategies with certain important components.”
Please note: “existing statutory and regulatory requirements”
If in fact 17,000 Missouri children have lost coverage then it is the state that has not met: “existing statutory and regulatory requirements” as the GAO has stated. The the CMS claims the letter in question was not make a ‘rule’ in that it only pointed to existing statutory and regulatory requirements and how those would be applied.
Go_Fish: you are 1000% correct.
Again, you seem to be a bit confused.
The Centers for Medicare and Medicaid Services (CMS) — that is, the Bush administration — has claimed that the new rule it wrote wasn’t a new rule under federal law. The part of the GAO document you cite is merely repeating that claim. It’s not surprising that CMS would make it; if it were a new rule it would have been nullified because it hadn’t been submitted to Congress as required.
The GAO, which is an independent agency, has ruled that CMS’ new rule “is a rule under the Review Act. Therefore, it must be submitted to Congress and the Comptroller General before it can take effect.”
CMS’ claim that it is merely enforcing existing requirements is belied by the fact that Missouri has covered children in families earning up to 300 percent of poverty since 1998. Illinois and several other states sought — and received — approval from the Bush administration, through CMS, to expand coverage for uninsured children. That’s the very thing CMS now claims they could not do. Apparently, those existing regulations didn’t exist when CMS approved the coverage expansions.
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I’m thinking game, set and match to Mr. Carlton. Perhaps there will be an opening on the Supreme Court for him soon with those analytical skills.
Of course, I’m not objective. As my favorite candidate says,
“5000 children in our district lose their health care coverage when Akin voted to sustain the S-CHIP Veto. If you or someone you love lose their health care, you don’t want Todd Akin in Congress representing you.”
found, of course, if I’m allowed a small plug, at http://votebillhaas.com/
States are more than welcome to subsidize the health insurance of people who can already afford it. They are not, however welcome to use federal dollars to do so without sensible restrictions. They should take the initiative and raise their own taxes first.
The Bush administration has said that an eligibility limit of 250% over the poverty rate is more than generous. If states want to raise their eligibility to 300 or even 400%, as was the case in New York, they can knock themselves out. The GAO report has no teeth, though it will be cited in upcoming lawsuits. I wouldn’t expect courts to rule on it any time soon.
I do agree, however, that the issue should go before Congress. I would love to hear supporters of the program justify confiscation of money from middle and working class families to subsidize insurance for the well off.