Successful SCHIP Program Needs to Expand Despite Veto

The future of medical care for millions of American children — including almost 200,000 in Missouri — rests with a recalcitrant President George Bush.

The state children's health insurance program, or SCHIP, was established by Congress, including a Republican House, in 1997 to help cover children in families that couldn't afford insurance, but made too much money to qualify for Medicaid.

SCHIP has been eminently successful, extending insurance to 6.6 million children nationwide. The uninsured rate among children has dropped 25 percent since 1997 even while rates grew rapidly among adults. Yet 9 million children remain uninsured, generally because their parents work for employers that do not provide coverage, states haven't conducted adequate outreach to parents and SCHIP no longer has adequate funding.

The U.S. Senate and House voted to reauthorize the SCHIP program, which otherwise will end this month — and expand it to include up to 5 million children who mainly are already eligible, but have not enrolled.

President George Bush's response has been dumbfounding. Any president with such rock-bottom approval ratings ordinarily would embrace the chance to leave a legacy of better health coverage for children who are poor or barely middle class.

Instead, Bush has vetoed the legislation. He backed only a SCHIP funding extension that doesn't even cover all the current children enrolled.

Bush said House and Senate plans amounted to a "massive expansion of the federal role" in health care and added, "I believe government cannot provide affordable health care" — surely a surprise to seniors on Medicare. Bush told the Washington Post, "My concern is that when you expand eligibility ... you're really beginning to open up an avenue for people to switch from private insurance to the government."

I'm sure the private health insurance industry appreciates the president's vote of confidence, but someone on his staff needs to remind the president how SCHIP works.

Three-quarters of SCHIP children nationally are covered through private insurance plans under state contracts. In Missouri, the children in greater Kansas City and St. Louis — and along the I-70 corridor in between — are in private insurance plans under both Medicaid and SCHIP.

Bush, of course, is well aware that SCHIP has little to do with the rhetoric coming out of his administration in Washington. National SCHIP grew out of a program Bush began during his first term as Texas governor and provided subsidies for private insurance plans — without coverage denials for sick kids and other downsides of the insurance market. The Texas plan personified "compassionate conservatism" before that phrase became a cliché.

Bush, however, is using SCHIP to test battle themes against the growing enthusiasm among congressional Democrats and the nation for a universal health program — a conflict that won't occur until 2009 or later.

If the bipartisan support in the House gains 15 votes for the veto override, and the Senate holds firm in its veto-proof, bipartisan support for this popular SCHIP program - Missouri has the chance to reverse damage done the past three years to our children and their families.

Missouri aggressively enrolled as many eligible children as possible in SCHIP when it began operating. Missouri allowed children in families with up to 300 percent of the poverty level to participate, although higher-income families faced copays and premiums. The state's use of SCHIP largely was responsible for Missouri ranking among the states with the lowest uninsured rates for children and overall in the nation.

But the state's severe financial problems and Gov. Matt Blunt's 2005 legislation that slashed eligibility for Medicaid and SCHIP have cut deeply into the number of children who can qualify for or afford coverage.

Under Blunt's legislation, the state denied coverage to children who had access to "affordable" private insurance that cost $342 a month or less last year, even though the SCHIP program would have charged those same families premiums of only a few dollars. Missouri also began charging SCHIP premiums for families with incomes that reached only 150 percent of the federal poverty level.

The reaction among cash-strapped SCHIP families, while energy prices soared, was predictable. On Dec. 31, 2004, before Blunt took office, 92,520 Missouri children got coverage under SCHIP. By June 2007, the total had fallen 36 percent to 59,865.

The legislature this year curtailed the absurd "affordability" test that cost thousands of children access to health care.

As a physician and a state lawmaker, I feel compelled to emphasize what children have at stake in this struggle over the next two months.

Simply put, kids need to be as healthy as possible to learn and develop, academically and socially. They cannot delay treatment for chronic and acute illnesses for a couple of years until their parents happen to get a job with health insurance benefits. Such benefits are increasingly scarce for low-income workers.

Children in SCHIP and Medicaid are much more likely to have regular access to a family physician or clinic so they can receive immunizations, regular checkups and care for injuries. One-third of uninsured kids did not see a doctor last year.

Children in SCHIP and Medicaid are more likely to get treatment for asthma, learning disabilities or health conditions that require regular treatment with prescription medications, which are expensive under any conditions. Uninsured children are 70 percent more likely to receive no treatment for such common conditions as ear infections.

Of uninsured children, 20 percent have untreated vision problems.

A Missouri study found SCHIP children were 39 percent less likely to miss school. A California SCHIP study found that 68 percent improved their school performance, and they also had better school attendance. The same applied to Florida, which found that uninsured children were 25 percent more likely to miss school.

Under the SCHIP legislation in Congress, Missouri stands to gain almost an extra $1 billion over the next five years to help cover care for more of our 120,000 uninsured children, not to mention continue care for the 60,000 in the program today.

Missouri desperately needs this funding to help reverse the recent increase in uninsured residents that it has seen. The new census data, released in late August, indicates that the total uninsured residents grew by 103,000 and Missouri children under 18 without health insurance increased by more than 25 percent in 2006.

We owe our most vulnerable young citizens the opportunity to develop into healthy, productive adults.