The Reauthorization of the State Children's Health Insurance Program (S-CHIP)--A Surprising Contrary View

Bill Boyles, the publisher of Health Market Survey, fills the role of guest commentator again today reporting on a very different view on the issue of the reauthorization of the State Children's Health Insurance Program (S-CHIP).

His report just goes to show that nothing in health care policy is simple:

House Black Caucus Not Buying S-CHIP Expansion

It seems like every interest group in the country is backing a huge expansion of the Medicaid child health program as a “first step” in covering the uninsured. From hospitals to heart surgeons to health plans everybody is finally nodding in agreement – the way to cover the uninsured is by “covering children first” to the tune of at least $50 billion over 10 years. It’s easy and it’s cheap. And most important it let’s politicians help children and appear to help families.

But wait. I found out this morning that there is a huge political force against expanding SCHIP, and it’s not Bush or the right wing – it’s many members of the Black Caucus in the House, the very people with large Medicaid populations in their own District. That’s right, many of the very members of Congress who have the most Medicaid members are fuming over the idea of pumping $50 billion into expanding the Medicaid children’s health program at a time when the chronically-ill uninsured are ignored and should get the money first.

The way it was described privately at a meeting led by a senior staff member for House Ways & Means Committee Chairman Rangel Tuesday, all of that money going to cover healthy children should be used for the people who really need it – the “55-year-old like me” who has diabetes or heart failure of mental illness. Medicaid funds are being used to send hundreds of thousands of healthy children of the chronically ill, near-poor diabetics to a doctor -- while the actual sick person in the family sits on park bench and can’t afford to go anywhere except the ER or a public hospital, if they can afford the copay.

Independent policy experts and a few economists who study Medicaid were not surprised. For years they have been criticizing S-CHIP as a give-away to the “primary care lobby” such as pediatricians who stand to gain big time. Two weeks ago the American Academy of Pediatrics even came out of the closet and began criticizing high-deductible health plans as bad for children. No coincidence that the source of funding for the big boost in S-CHIPs is the same insurers offering high-deductible plans alongside Medicare Advantage plans. Pediatrician lobbyists know that cutting Medicare private plans is the only way to fund the huge expansion in SCHIP that will increase their incomes.

The latest issue of the prestigious journal Health Affairs plays along with the sudden power of the primary care specialist lobby, with an entire issue devoted to how to cover children -- and not a word about what to do about their parents.

What would the Black Caucus members and Rangel and the policy analysts do instead? No mystery about that – give the money to the people who really need help, the low-income chronically-ill who don’t quality for Medicaid. But that involves the much less-attractive and tough-nut options such as expanding Medicaid to cover this desperate population, or encouraging states to use existing S-CHIP money for parents, or giving public hospitals and clinics – or health plans – money to find the chronically-ill poor and get them in the system.

Unfortunately, a poor older diabetic just can’t match a poster child.