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More than 150 years ago, William Blake famously urged us “To see a world in a grain of sand, And a heaven in a wild flower.” Beautiful poetry, these words make lousy advice to lawmakers grappling with real-world problems.
If the country’s leaders perceive policy issues not as problems demanding concrete solutions, but as embodiments of universal ideological struggle, enacting workable laws becomes much tougher. Unfortunately, the federal debate over children’s health care is now enmeshed in ideological drama.
Congress is presently reauthorizing the State Children’s Health Insurance Program (SCHIP). An enormously successful program, SCHIP has shrunk the ranks of uninsured low-income children by more than a third. Yet Al Hubbard, one of the president’s chief economic advisors, raises “philosophical and ideological” objections to program expansion, and a letter-writing campaign launched by federal officials warns that SCHIP reauthorization could trigger “a government takeover of the health care marketplace.”
Such claims falsely depict a grain of health policy sand as a philosophical world. SCHIP is hardly the stuff of Michael Moore’s dreams. Born of bipartisan compromise in 1997, SCHIP gives children private health insurance, not public-sector health care. SCHIP is a block grant to states, with federal costs strictly capped. Offering states tremendous flexibility, SCHIP has no federally mandated benefits package and is not an entitlement program.
The bipartisan plan recently approved by a 17-4 vote in the Senate Finance Committee would not change any of these features. SCHIP would remain a more conservative alternative to Medicaid, just as when the program began.
The Finance Committee plan would, however, offer states additional resources and restructure the program to reach uninsured children more effectively. As a result, 6 million additional children would receive Medicaid or SCHIP by 2012, according to the Congressional Budget Office (CBO). Of these children, 4 million would otherwise have been uninsured, including nearly a million currently enrolled children who would have lost coverage without an increase in funding.
Even before this plan was written, the administration was threatening a veto. U.S. Department of Health and Human Services Secretary Leavitt objected that SCHIP proposals might double the program’s income limits. However, states have had the flexibility for decades to provide Medicaid and SCHIP to children up to any desired income level. It is thus not surprising that, according to CBO, the vast bulk of the uninsured children reached by the Finance Committee’s proposal—all but 600,000 children—have low enough incomes to qualify for Medicaid or SCHIP under current program rules.
Secretary Leavitt further objected that “most of the children they want to add to SCHIP already have private insurance,” and President Bush predicted that SCHIP reauthorization would become “Congress’s attempt to federalize medicine.”
However, the CBO found that the bipartisan Senate plan would shift only 2 million children from private coverage to Medicaid or SCHIP. According to the Census Bureau, nearly 50 million children received private insurance in 2005. Fewer than 1 in 20 privately insured children would thus move to public programs under the bipartisan Senate proposal. To paraphrase Mark Twain, rumors of a government takeover of the health care marketplace have been greatly exaggerated.
When the Senate proposal was first released on July 13, the administration’s earlier worries proved unfounded. Yet ideological factors continue to prompt a veto threat. In Secretary Leavitt’s words, “the health care conversation needs to be not just about how we insure uninsured children,” and the president continues to describe SCHIP proposals as “a massive expansion of the federal role in providing health care.”
Legitimate questions are at stake in the debate over SCHIP reauthorization. How much flexibility should states have to cover children in moderate-income families? Should states have the option to cover parents and legal immigrant children? How can policymakers prevent SCHIP from replacing employer coverage? How much federal money do states need to enroll all their eligible children? And what new tools and incentives would let states finally reach the millions of uninsured children who qualify for health coverage but are not yet enrolled 10 years after SCHIP’s creation?
Such questions deserve serious discussion. And legitimate answers could save as well as cost money. But wise and practical answers are more likely to emerge from pragmatic problem-solving than from the ideological holy wars now gathering steam.
Millions of uninsured children are depending on both ends of Pennsylvania Avenue to look at the SCHIP sand without seeing a fictional ideological world. Only with such clarity of vision can the country’s leaders make the sensible, practical decisions that will help America’s children grow up healthy and strong.
Stan Dorn is a senior research associate in the Urban Institute’s Health Policy Center. During the original enactment of SCHIP, he served as health policy director at the Children’s Defense Fund, which played a major role in passing the law.
The views expressed are those of the authors and should not be attributed to the Urban Institute, its sponsors, staff, or trustees.
