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Playing politics with kids' lives



Earlier this year, wary observers were hoping against hope that the traditionally bipartisan issue of children's insurance wouldn't become entangled in ideologically driven, election-season debates over healthcare reform.

But that's precisely what's happening this summer as Congress and the Bush administration square off over reauthorization of the State Children's Health Insurance Program (SCHIP), the federal-state partnership aimed at kids whose families earn too much to qualify for Medicaid but not enough to buy private insurance.

A bipartisan Senate proposal, passed 68 to 31, would increase current funding levels by $35 billion over the next five years, bringing total SCHIP funding to $60 billion. House Democrats have pushed for an even bigger boost, as much as $50 billion extra over the same period, funded in part by rolling back subsidies to private Medicare plans. The House bill would also replace upcoming cuts in Medicare payments to doctors with modest increases in each of the next two years.

In stark contrast, the administration has targeted an increase in SCHIP funding of only $5 billion or so over the next five years. The bigger Senate amount will trigger a presidential veto, administration officials have repeatedly threatened. Besides being fiscally irresponsible, calls for expanding SCHIP to new enrollees will make those children "dependent on government programs for health insurance coverage," Department of Health and Human Service's Secretary Michael Leavitt wrote in a letter to Sen. Max Baucus (D-MT), chairman of the Senate Committee on Finance. The administration's own plan for covering more kids-like its plan to cover more of the uninsured generally-is to expand individual tax credits, something the Senate proposal doesn't take up, in part because many Democrats and moderate Republicans find it so controversial.

Doctors push for more funding

To date, organized medicine has sided with those calling for extra dollars. At the annual House of Delegates meeting in June, the AMA adopted a policy to lobby Congress to provide $60 billion in additional SCHIP funding. Among the leaders of the floor fight for inclusion of that specific amount was pediatrician Melissa Garretson, a member of the American Academy of Pediatrics Access Subcommittee of the Committee on Federal Government Affairs.

"As physicians, we need to set out the specific numbers necessary to provide coverage for children in this country," says Garretson, an emergency medicine specialist at Cook Children's Medical Center, in Ft. Worth, TX. "We can't let others do this because they'll decide to decrease money for the program and put it somewhere else."

Garretson, a Republican, says she's disappointed with the president's "stance on children's health issues." Although no fan typically of government entitlements programs ("As a Texan, I truly get the whole idea of personal responsibility"), she draws the line at children.

"They don't pick the situations they were born into or the choices their parents make," she says. "And so, if you put kids in a situation where they don't have many options, we as a society need to make a commitment to take care of them."

As for Garretson's message to those who refuse to make that commitment on ideological grounds: "To play politics with children's lives is just wrong."

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health