WASHINGTON -- President Bush and other critics of a $35 billion
spending increase for children's health insurance say they'll support
expanding coverage to families of four making as much as $62,000 a
year, but they want to limit states' ability to go beyond that level.
About
three dozen states ignore certain income when determining who can get
government-subsidized health coverage. For example, many states exclude
child support payments. Others deduct expenses for child care when
determining who qualifies for the State Children's Health Insurance
Program.
Congress is considering the renewal of SCHIP for
an additional five years, but differences remain over who the program
should cover and how much money should be spent. The flexibility that
states have in defining income is one of the differences that will
probably need to be resolved for Democrats to override a promised veto
from Bush.
So far, the issue of "income disregards" has
received little attention, but that started to change in last week's
debate on the House floor.
"You leave it up to the states
to say you can't have an income level over 300 percent (of poverty),
but you can deduct $20,000 for a housing allowance or you can deduct
$15,000 for shelter or whatever," said Rep. Joe Barton, R-Texas. "So,
what you've got here is the classic bait and switch."
Rep.
John Dingell, D-Mich., said that allowing states to exempt some income
helps to ensure that low-income families don't have to resort to
welfare to get health care for their children.
Another
disagreement over the program's future is over the coverage of adults,
even though the Bush administration approved most of the waivers that
allowed adults into the SCHIP program. Now, the administration wants to
remove those adults from the SCHIP rolls more quickly than called for
in the bill that passed the House last week.
Under that
bill, states would have to move an estimated 200,000 childless adults
off SCHIP within one year. Also, by 2010, waivers covering about
500,000 parents would be paid from a separate fund. States that perform
well on covering low-income children could continue covering parents
through that fund, which would get a lower federal matching rate than
under current policy, Dingell said.
Just last year,
administration officials testified during congressional hearings that
extending SCHIP coverage to parents increased the likelihood that their
children would get health insurance too. But Health and Human Services
Secretary Mike Leavitt now calls the coverage of parents an experiment
that took resources away from poor kids. About a dozen states received
waivers to cover parents through SCHIP.
"All adults should
be moved off SCHIP when their state waivers come up for renewal or
within one year, whichever comes sooner," said a policy statement
issued by the White House last week.
The bill that passed
the House on Thursday would allow about 3.9 million more uninsured
children into SCHIP by 2012 -- on top of the 6 million now enrolled. An
additional 2 million children would leave private coverage by then and
enroll in SCHIP, according to the Congressional Budget Office.
The
president had recommended spending an additional $5 billion for SCHIP
over the next five years. The bipartisan bill before Congress calls for
a $35 billion increase, bringing total spending to $60 billion.
The
administration announced last week that it could support policies that
require more money than it previously recommended. Still, Leavitt cited
about $10 billion that he believes should be trimmed from the bill
before Congress.
The administration remains adamant that it
won't support a tobacco tax increase to pay for SCHIP's expansion.
Instead, it's calling on lawmakers to pick from $96 billion worth of
new fees or spending cuts that were part of the president's budget this
fiscal year. However, most of those proposals generated little support
in Congress.
Among those recommendations were higher
co-payments at the pharmacy for some veterans who are not disabled.
Their copays would increase from $8 to $15 under the president's
budget, saving about $1.6 billion over five years.
Bush
also wants to make higher-income Medicare recipients pay more for their
drug coverage as well as for their insurance for doctors' visits.
Higher premiums for the drug benefit and doctors' services would
generate more than $10 billion over five years, according to his budget.
The
bill to expand SCHIP relies on a 156 percent increase in the federal
cigarette tax, taking it to $1 per pack from the current 39 cents.
Supporters
of the tax increase cite high public support for a tobacco tax. The
Kaiser Family Foundation released a poll Friday showing that about 70
percent of those polled supported expanding SCHIP by $35 billion
through higher tobacco taxes.
Tobacco tax supporters say higher prices for cigarettes deter smoking and save lives.
"The
health benefits of higher cigarette taxes are substantial," says a 1990
report from the surgeon general. "By reducing smoking, particularly
among youth and young adults, past tax increases have significantly
reduced smoking-related morbidity and mortality."
The
Senate is expected to take up next week the bill passed by the House.
Democratic leaders are scheduled to meet Monday with a handful of
Republicans seen as crucial to deciding whether more changes to the
bill will give backers the all-important two-thirds majority necessary
to override a veto.