Kaiser Daily Health Policy Report

Monday, July 09, 2007

Capitol Hill Watch
Democrats Work To Reauthorize, Expand SCHIP While Bush Administration Tries To Limit Program Growth

Congressional efforts to reauthorize SCHIP, which expires on Sept. 30, are "intensifying," but the Bush administration "has taken several steps to slow momentum for expansion of the program," the New York Times reports (Pear, New York Times, 7/9). Members of the Senate Finance Committee are close to reaching an agreement on legislation that would reauthorize and expand SCHIP and hope to mark up the bill this week, according to a committee aide. Sen. Jay Rockefeller (D-W.Va.) said lawmakers before the July 4 recess reached an agreement on most of the basic principles of the legislation and now are working out the details.

Meanwhile, Democrats on the House Energy and Commerce Committee this week expect to finish a discussion draft of SCHIP legislation (CongressDaily, 7/9). Many Democratic lawmakers support proposals to increase funds for SCHIP by about $50 billion over five years. President Bush has proposed increasing SCHIP funds by $4.8 billion over five years. Bush also has called on lawmakers to refocus the program on low-income, uninsured children by reducing federal funds for states that have expanded SCHIP eligibility to children in families with annual incomes more than 200% of the federal poverty level. At least 17 states would lose federal funds as a result of the proposal (Kaiser Daily Health Policy Report, 6/28).

White House Opposition
According to the Times, the "ideological battle" over the program "epitomizes fundamental disagreements" between Democrats and the Bush administration "over the future of the nation's health care system and the role of government." White House officials believe an expansion of the program would erode private insurance and take the country closer to a government-run health care system (New York Times, 7/9).

Bush last week called an expansion of SCHIP "the wrong path for our nation." He said, "Government-run health care would deprive Americans of the choice and competition that comes from the private market" (Zhang, Wall Street Journal, 7/7).

Allan Hubbard, assistant to the president for economic policy, said that White House objections to Democrats' SCHIP expansion proposals are "philosophical and ideological" and that a "single-payer health care system with rationing and price controls" would result from an expansion.

The Times reports that the White House recently has taken steps to limit support for SCHIP expansion, including the release of an HHS study that found one million uninsured children currently are eligible for Medicaid or SCHIP, compared with previous estimates by "private researchers and government experts" of five million children; a letter-writing campaign by regional HHS directors to newspapers warning of "a government takeover of the health care marketplace" with an expansion of the program; and urging Congress to include Bush's tax credits for individual health insurance plans in any SCHIP legislation (New York Times, 7/9).

House Leadership
Meanwhile, in a June 28 letter from House Energy and Commerce Committee Chair John Dingell (D-Mich.), House Ways and Means Committee Chair Charles Rangel (D-N.Y.), Rep. Pete Stark (D-Calif.) and Rep. Frank Pallone (D-N.J.) says, "It is vital that we present a united front on [SCHIP] legislation. The administration will battle us every step of the way, and we cannot count on any votes from the other side of the aisle." The letter adds, "Failure to act will increase the number of uninsured children and severely curtail state health reform efforts."

A bill drafted by the lawmakers would allow older children, children of documented immigrants and pregnant women to enroll in SCHIP. House Democrats also proposed strengthening traditional Medicare by increasing spending on lower-income, rural and elderly residents (Wall Street Journal, 7/7).

In addition, the lawmakers in the letter said they plan to defer for two or three years a planned 10% cut in physicians' Medicare payments. The letter also "insinuated [House Democrats] will take a stab at overhauling some of Medicare's payment systems, particularly within Medicare Advantage," according to CongressDaily (CongressDaily, 7/9).

Opinion Piece
Reauthorization of SCHIP "is not in question," but "whether we will build upon SCHIP to strengthen the national health care safety net or will retreat from ensuring health care to the nation's children is the cause of a serious clash in Washington," Bill Bentley, president and CEO of Voices for America's Children, writes in a Washington Times opinion piece. According to Bentley, the "real issue" for SCHIP reauthorization is not "whether it conflicts with private health insurance, but whether we have the national will to fully address the most basic needs of our children" (Bentley, Washington Times, 7/8).

Broadcast Coverage
PBS' "Now" on Friday reported on the debate over SCHIP reauthorization. Video of the segment and expanded "Now" coverage are available online.