Expand Health Insurance to Our Uninsured Children
Why does our government stand in the way of expanding health insurance coverage to uninsured children? A Census Bureau report last week revealed that the number of uninsured children nationally increased in the past year by more than 600,000 to a total of 8.6 million.
Last month, the Centers for Medicaid and Medicare Services at the U.S. Department of Health and Human Services arbitrarily set limitations on state expansion of child health programs for children in families above 250 percent of the federal poverty level. The programs in question, the State Children’s Health Insurance Program (SCHIP), offers private health insurance, at a subsidized rate, to children in families with incomes above Medicaid’s strict limits. Because states use their significant purchasing power to bring down costs, SCHIP allows moderate- and low-income families to afford high quality insurance for their children on a sliding income scale.
415,000 Uninsured
Currently, there are about 415,000 uninsured children in New York State. Nearly half – 200,000 – are Black and Latino children. The goal of SCHIP is to reduce the number of uninsured children. New York is one of 17 states seeking to extend eligibility under the SCHIP program to children whose family income levels are above 250 percent of the federal poverty level. The state believes that, with this proposed expansion, nearly all children in New York would have access to publicly administered health insurance through private insurance plans.
In our 2007 survey of low-wage New Yorkers, the issue of health care and prescription drugs emerged as the greatest worry among the working poor. Our research shows that 32 percent of the respondents above 200 percent of the federal poverty level do not receive health insurance through their jobs for themselves and nearly half — 44 percent of respondents — do not receive insurance for their families.Edict violates
statutes
Indeed, over the past three years, our survey has documented a pronounced decline in the percentage of poor full-time working respondents who report receiving health insurance by their employers - from a high of 58 percent in 2003-2004 to a low of 27 percent in 2005-2006. This is part of a national trend away from employer-based health insurance. A result of the erosion in employer-based coverage is the increase in the number of children without health insurance.
Governor Spitzer is currently deciding whether to sue the federal government if New York State is not allowed to expand its SCHIP program. The state should fight the blockage of expanding SCHIP. The government’s edict violates several legal statutes.
First, the new federal rules were imposed without the public comment period as required by the federal Administrative Procedures Act. No doubt, New York and a number of other states would have a lot to say about the recent changes. Yet they are shut out of a decision making process that was enacted for just this type of situation – an arbitrary pronouncement by the federal bureaucracy.
State Flexibility
Second, the new rules contradict the SCHIP law by nullifying state flexibility. When SCHIP was created, Congress included provision for state flexibility – each state was free to adjust its programs to reach as many children as possible. As with the cost of living, the cost of health insurance in New York is much higher than in many other places across the country. So expanding SCHIP upward in New York is necessary in order to include as many children as possible. This is one reason why many other states also want to expand their SCHIP programs.
One of the new restrictions that would make it virtually impossible for states to expand SCHIP is the requirement that 95 percent of children below 200 percent of the federal poverty level be covered prior to an expansion of the program. A 95 percent coverage rate is patently unachievable in the real world. The new rule appears to intentionally impose an insurmountable barrier that no state could overcome.
Moving from the impossible to the foolish, another new rule imposes a one-year waiting period before a child can enroll in a health plan. This is a prescription for individual and public health disasters. Asking a child to wait for a year to see a doctor is dangerous and inhumane, but forcing children to wait a year before getting insurance coverage so that they can get preventive care such as vaccinations is senseless and threatens the public health of all our state’s children.
New York’s Congressman Charles Rangel, chairman of the House Ways and Means Committee, has been a strong supporter for expanding access to health care for children. Congressman Rangel pointed out that “flexibility has been the cornerstone of SCHIP’s past success, allowing states to design their programs based on local needs, values, and economics. So if we allow local adjustments in federal subsidies in housing and Medicare, why wouldn’t we do so in safeguarding the health of our youngest generation?”
The lack of affordable, comprehensive health insurance hurts individuals, health care providers, and the community at large. There is no reason why 8.6 million children – including 200,000 Black and Latino children in New York State - should be without health insurance in the world’s richest nation. The government should rescind these shortsighted rules. State expansion of SCHIP programs should be allowed.
From the New York Amsterdam News
September 6 – 12, 2007
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