Failing America’s Neediest Children

Back in the days of the Republican Revolution, when Newt Gingrich declared Bill Clinton to be irrelevant, only to discover that the president of the United States is relevant; when Republicans forced a shutdown of the government to prove their point that Americans wanted deep cuts in popular programs such as Medicare, only to discover that they don’t; when Clinton won re-election and it was clear that he was not going away, Clinton and Gingrich at last joined hands and seemed to sing political “Kumbaya.”

They reached deals that, at the time, were praised as the productive fruit of bipartisanship. One of them was a 1997 budget agreement that simultaneously helped to move the federal budget further toward balance and created a new government program — the State Children’s Health Insurance Program (SCHIP) — that fused Democrats’ desire to extend health insurance to those without it with Republicans’ demand that no top-down system be created to do so. SCHIP insures low-income children through a combination of federal money and state partnerships with private insurers. It is both successful — reducing the number of uninsured children by a third — and wildly popular.

“The joke sometimes on the Hill is that everybody, whether they are Republicans or Democrats, thinks of themselves as the father or mother of SCHIP,” says Cindy Mann, a professor at Georgetown University’s Health Policy Institute.

Now the Bush administration has decided to make it an orphan.

It threatens to veto a bipartisan measure to reauthorize the children’s health program, even though the plan has overwhelming support in the Senate and a similar version would easily pass the House. The usual combination of ideology leavened with untruths is used to pump up conservative criticism of the program, though for a decade there’s been almost none.

SCHIP is tantamount to a “Washington-run, government-owned plan where government makes the choices, where government sets the prices, where government then taxes the people to pay the bill,” Health and Human Services Secretary Michael O. Leavitt told reporters recently. The White House also opposes a planned tobacco tax increase to help pay for the insurance.

But much of what Leavitt says is untrue. State governments, not “Washington,” run the program. They in turn pay private managed-care insurance plans to cover the children, as they do for most children now enrolled in Medicaid. States, not Washington, determine income-eligibility limits and specify the benefits covered, in conjunction with the private insurers. In other words, the children’s health program works much more like employer-sponsored health insurance than it does a “government-owned plan.”

This is what Gingrich intended.

During the debate over creating the new program, Republicans insisted that it not be a government “entitlement” — like Medicare and Medicaid — under which all those who qualify for benefits are guaranteed them. The insurance plan was created as a block grant to states, with funding capped — so that as states ran out of money (say, because of ever-rising health care costs) they couldn’t serve more children even if the kids qualified for help. This is, in part, why there are still 9 million uninsured children. Nearly half of them — 4.1 million — would be helped under the Senate version of the measure. Of those, 3.5 million are in families with incomes that already make them eligible for the government programs, but they haven’t been enrolled for various reasons.

“The position that the White House is taking is far to the right of the position that Newt Gingrich and the rest of the Republicans took in 1997,” says Robert Greenstein, director of the Center on Budget and Policy Priorities, which analyzes and promotes programs for low-income people.

The 1997 deal passed unanimously in the Senate. In the House, the majority of votes in favor came from Republicans, many of them known at the time as conservative firebrands. To the White House, this now seems like some historical mistake — though candidate George W. Bush, in 2004, pledged to lead an “aggressive effort” to enroll millions of poor children who were eligible for government-subsidized health insurance but weren’t being served. This is the group the Senate measure would target for help.

One day historians — and who knows, maybe a small army of shrinks — will dissect the essential mystery of the Bush era. Why, with so much ineptitude obvious on so many fronts, does the president persist in creating more opportunity for failure? Especially when those he would fail are our neediest kids.

Marie Cocco’s e-mail address is mariecocco(at symbol)washpost.com.

© 2007, Washington Post Writers Group