The push to maintain funding of state-provided health insurance for lower and middle income children has become yet another political hot potato in the nation's capital.
As the standoff over renewing the State Children's Health Insurance Program continues in Washington, many states, including Georgia, are scrambling to find ways to keep their programs solvent if the 10-year-old initiative expires at the end of the month.
The problem isn't with the program itself: Republicans and Democrats at the national and state levels agree it has worked well. By offering health insurance to children whose parents do not qualify for Medicaid and who don't have employer-provided coverage, everyone wins. Children are healthier, which is good for them and their schoolmates who won't catch whatever they might be spreading; families aren't stretched to the limit to pay medical bills they can't afford; parents are more likely to seek earlier care for ailing children to head off major illnesses; and emergency rooms are less burdened by cases that should be handled by primary care physicians.
Many GOP lawmakers and governors, including Georgia's Sonny Perdue, know the benefits of SCHIP and want to increase its funding to meet current and future needs. The PeachCare program serves some 280,000 children in Georgia.
The impasse over funding the SCHIP plan in Washington is over how much the program should be expanded and who should be included.
House and Senate leaders in Congress have proposed an expansion of the SCHIP program of $35 billion, well above the $5 billion uptick the White House prefers. Funding for the plan would be offset by higher tobacco taxes.
Much of the debate centers on who would qualify for the government-provided insurance in participating states; in a few instances, states are looking to expand coverage beyond children. The income level for qualifying families also is a point of contention.
President Bush has vowed to veto a proposal to expand the program to that extent. The White House claims that raising the income qualifications might prompt some to drop their employer-provided health packages in favor of the government plan, though some states have included a provision to head off that concern.
Bush also doesn't want to see a incremental expansion of government's role in providing health coverage. "I believe this is a step toward federalization of health care," he said Thursday.
Democrats are using his opposition to the bill to score political points, saying a veto sends a message that the White House doesn't care about caring for children. Such partisan rhetoric only serves to set up an ongoing battle that will carry into next year's elections.
Yet concern over how far and fast to grow the program are valid. SCHIP needs to remain a safety net for poor and middle-income children who need health insurance, but not a long-term entitlement program that establishes state or federal government as the chief health care provider. The original goal of the program and its success prove that government can maintain a carefully managed role in providing health insurance to those in need.
But while the bigger picture matters, a solution to the SCHIP crisis is needed now before the program expires and states have to cut services. The president proposed passing a temporary extension to the program until a permanent solution can be found. That's likely to happen, but it just puts off the hard decision until later, and with the same disagreements still firmly in place. With elections looming, long-term answers will be harder to come by, not easier.
Gainesville U.S. Rep. Nathan Deal backs a House bill that would keep SCHIP in place for 18 months at $5 billion per year, increasing $1.5 billion next year and another $1.1 billion for 2009.
"Now is not the time to playing a game of chicken with the White House when children's health care and insurance are at stake," Deal, ranking GOP member of the House Energy and Commerce Health subcommittee, told The Times last week.
To end the stalemate, Congress should begin by giving states the power to set their own limits and qualifications. One-size-fits-all federal programs don't give them that leeway. For instance, a family income of $60,000 might make you well-off in Georgia, but not in states where the cost of living, and subsequently health care expenses, are much higher.
As with so many other contentious issues, what's needed are compromise and common sense. Congress should unite behind a bill that expands the program to a reasonable level, one the White House can accept. The gap between $35 billion and $5 billion offers plenty of wiggle-room to come up with a workable figure that may not please everyone, but keeps the program going without requiring major cutbacks. Meanwhile, the president should drop his opposition to the way states apply the funds and let them make decisions to best suit their residents.
The SCHIP program itself is a win-win. A solution to keep it going needs to be as well.
Originally published Sept. 23, 2007