Late on a Friday afternoon in the middle of the August congressional recess, after the House and Senate passed legislation reauthorizing and extending the State Children's Health Insurance Program, the Bush Administration issued harsh and restrictive rules for SCHIP that would make it virtually impossible for states to extend health coverage to many of America's more than nine million uninsured children.
The new rules issued by the Centers for Medicare and Medicaid Services (CMS) would prohibit states from expanding SCHIP health coverage to children whose families have incomes above 250 percent of the federal poverty level—$51,625 for a family of four—unless the states fulfill a number of onerous requirements that no state has been able to meet. This is particularly egregious considering that the average annual private insurance premium for a healthy family of four is more than $12,000.
SCHIP was enacted 10 years ago to provide health insurance to children whose families earn too much to be eligible for Medicaid but not enough to afford private insurance. Up until now, eligibility has varied by state. Pennsylvania's SCHIP eligibility is 300 percent of the poverty level and New Jersey's is 350 percent. In an effort to extend coverage to all 400,000 of New York's uninsured children, at Governor Eliot Spitzer's urging the state's legislature raised its limit to 400 percent of poverty — about $82,600 for a family of four. The Administration rejected New York's application for approval of the change. That means that 60,000 children in New York could remain uninsured.
The new rules proposed by the Bush Administration would prohibit any state from covering families with incomes above 250 percent under SCHIP until the state had first enrolled at least 95 percent of children in families earning below 200 percent of the poverty level who are eligible for either Medicaid or SCHIP. This is a level of participation that no state has been able to achieve.
And the rules include more hurdles. States must charge participating families co-payments or premiums that approximate the cost of private coverage, and they must also impose waiting periods of at least one year without insurance on families to make sure they don't go right to SCHIP from a private insurance plan. There are no exceptions, even if a child's parents had just died.
That means many children would have to go a full year without coverage for preventive care, well-child doctor's visits, immunizations, or even treatment for serious illnesses. Could the drafters of this policy somehow be unaware of what this would mean to children, or do they simply not care? This restrictive policy will drive tens of thousands of children into emergency rooms when they get sick—the most expensive kind of care.
States looking to cover more children in the over-250 percent category must show that the number of children in the target population insured through private employers has not decreased by more than two percentage points over the previous five years; in other words, that SCHIP did not become a substitute for private health insurance coverage. What the president doesn't seem to recognize is that more and more employers are dropping health coverage for their workers or making employees' contributions for coverage so expensive that the families can no longer afford it.
Several states have extended SCHIP to thousands of uninsured children. But the Bush Administration sabotaged these efforts when it issued the proposed new rules. These unreasonable administration restrictions, which were issued without congressional approval or public comment, will take us back to a time, two years ago, when a million fewer children had health coverage. New Jersey Gov. Jon Corzine is standing up for the children in his state by disregarding the new restrictions and continuing to serve children in families with incomes as high as 350 percent of the federal poverty level. Had he not taken this courageous position, as many as 10,000 children in his state could lose coverage.
A group of 44 Democratic and Republican senators have expressed their strong opposition to the Bush Administration plan, stating that "the new restrictions outlined in the CMS letter impose unnecessary and insurmountable roadblocks to states working to help additional uninsured children."
They conclude that "not only is this bad public policy but it could actually harm America's children." They appealed to President Bush to withdraw the new proposed regulatory requirements.
The Bush Administration's new rules are appallingly cruel and insensitive, and clearly counter to the intent of Congress when it enacted SCHIP legislation. These rules jeopardize the ability of states to extend health coverage to many uninsured children at risk of living sicker and dying sooner than their insured counterparts. This is not a partisan issue. The current SCHIP legislation is simply about doing more of what's right for more children. President Bush needs to read and follow his Bible's New Testament more closely. Jesus said let all the children come, not just Mr. Bush's or others born to privilege. He should drop his destructive new SCHIP rules and sign this modest health bill.
Marian Wright Edelman is president of the Children's Defense Fund.
