With the showdown this week between conservatives and progressives over a proposal to reauthorize and expand the hugely popular and effective State Children’s Health Insurance Program (SCHIP), the health care debate has naturally shifted to Washington. With the recent Presidential veto, the debate has become even more critical.
Opinion: Covering Minnesota kids needs to remain our focus
It also demonstrates clearly how intertwined state and federal interests are when it comes to health care policy and how important it’s going to be for Minnesota officials to work with the federal government in finding a solution to the growing health care crisis in this country.
The outcome of this reauthorization debate is going to have a huge impact in Minnesota. If it passes, it could provide Minnesota with $50 million or more each year to cover more kids and their families. A sustained veto, however, could cost the state as much as $88 million a year.
SCHIP was created in 1997 to help cover the growing number of children nationwide whose families couldn’t afford decent health insurance but who made too much to qualify for Medicaid.
The program has been incredibly successful. Over its first 10 years, it is credited with reducing the number of low-income children without health insurance by about one-third. About 6.6 million children nationwide are covered through the program, 36,000 of them in Minnesota.
Minnesota is also one of 13 states granted a waiver to use the federal funding to insure parents and pregnant women through the MinnesotaCare program. That has allowed us to cover a total of 120,000 Minnesotans, including 80,000 family members (parents and children), 5,000 pregnant women and infants and 35,000 adults without children.
Because of SCHIP’s proven track record, there’s fairly broad bipartisan support within Congress and among the public for expanding the program. The plan also is supported by most health industry organizations, the majority of the nation’s governors, religious leaders and patient advocacy groups.
The plan, vetoed on October 3, passed the Senate October 4 with a veto-proof vote of 67-33 and the House on a narrower 265-159 vote (well short of a veto-proof, two-thirds majority), would cover an additional 5.8 million children by 2012. The projected cost is $35 billion, which would be paid by a 61-cent increase in the federal tobacco tax.
A majority of conservatives in Congress don’t quibble with the success of the program or even dispute that the expansion will cover more children in an efficient manner. What they object to is the philosophical underpinnings of the program: They see it as a step toward universal government-run health care.
They claim the expansion will turn a program intended to cover poor kids into one for the middle class. In reality, some kids from middle-income families would be covered – the income limit is $62,000 for a family of four – but of the 5.8 million kids who would get coverage under the plan, the vast majority – about 85 percent – would come from families with incomes of less than 200 percent of the poverty rate.
Critics also claim it undermines the private health care market. Yet this market is obviously broken, producing worse outcomes than public health care systems in the rest of the industrialized world. Raising the bogeyman of universal government–run health care isn’t going to work here.
SCHIP was set to expire Sept. 30, but Congress extended it through Nov. 15. That will give supporters time to build support for an override.
Without reauthorization, our status as a national leader in health care coverage could be threatened. Minnesota is among the 35 states facing an immediate shortfall if SCHIP is eliminated, and a sustained veto would leave a huge hole in our budget that could affect passage of a comprehensive transportation funding package, property tax relief, school funding and more.
It could also damage existing programs such as MinnesotaCare through eligibility changes or enrollment cuts. The long-term impact could be devastating for the hard-working Minnesotans who rely on this program for their health care.
But even if an override is successful, Minnesota could still be in trouble. This summer, the Bush administration established harsh new rules requiring SCHIP funding to be used only for children. Minnesota health officials are scrambling to figure out how to allocate the new funding if these requirements are enforced.
If the new requirements stick, Minnesota would have to prove that MinnesotaCare is not causing a decline in employer-based coverage. But how can the state prove that? Employer coverage has been dropping pretty much everywhere. That’s why MinnesotaCare exists in the first place.
The new requirements also could force Minnesota kids onto a year-long waiting list before they qualify for subsidized care, a move sure to increase emergency room visits and uncompensated care in hospitals across the state.
Clearly, the outcome of the debate in Washington is important to our efforts to reform health care in Minnesota. However, we also need to remember that insuring kids remains a state responsibility, at least given the current climate in Washington.
For years, Minnesota has tried to do the right thing when it came to covering our children. In the mid-1990s, we consistently ranked at or near the top of the nation in the percentage of our kids with health coverage and in the top 10 in the number of low-income kids covered.
That commitment wavered in the past decade as Minnesota dropped to 22nd in the nation in low-income kids with health coverage. Part of that happened because of the success of SCHIP in other states, but the decline was mainly the result of the conservative health care cuts in 2003.
Most of those cuts were restored during the 2005 legislative session, but the uncertainty of SCHIP funding has put a cloud over those modest gains. If the federal funding doesn’t come through, the state will need to step up.
We can’t abide a repeat of 2003. Study after study has demonstrated that children with health insurance are more likely to have regular doctor visits, do better in school, suffer less from ailments such as asthma and ear infections and remain freer of chronic diseases as they age.
That means they use fewer health care resources down the road. That’s the way we need to think of programs like SCHIP and MinnesotaCare. They really are an investment in our future.
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