Kids Care, A Report Card

The subtitle of today's article du jour is, "Those that have the most access to insurance tend to have healthier children." This is hardly a shocking observation. What is shocking are the grades given to the various states of the U.S. by the Commonwealth Fund in their recent report U.S. Variations on Child Health System Performance: A State Scorecard. Steve Reinberg, HealthDay reporter for US News and World Report takes a look at the results:

According to the scorecard, if all states performed as well as the top few states:

• an additional 4.6 million children nationwide would have health insurance;
• 11.8 million more children would get their recommended yearly medical and dental check-ups;
• 10.9 million more children would have a "medical home" -- a regular source of care;
• 1.6 million fewer children would be at risk for developmental delays;
• and nearly 800,000 more children would be up-to-date on their vaccines.

Iowa, Vermont, Maine, Massachusetts, and New Hampshire are the top performing states, according to the report, while Arizona, Florida, Louisiana, Mississippi, New Jersey, Nevada and Texas are at the bottom.

As a Louisiana native, this is far from welcome, although unsurprising, news. With fifty states in the Union there are fifty different sets of standards being applied leading to a broad variance in results. Commonwealth Fund President Karen Davis stated in a Tuesday teleconference that more than a full third of American children receive care due to funding from the Federal Government and the states. SCHIP and Medicare were cited as crucial components in delivery of that care.

The scorecard took into account 13 indicators of children's health, including access, quality, costs, equity and the potential to lead a long and healthy life. While no state scored high on all categories, some regions surpassed others. For example, states in the Northeast and Upper Midwest often ranked higher in several areas, while the lowest rankings were in the South and Southwest, the report found.

Studies have shown that in states with high numbers of uninsured children, those children are less likely to get recommended health care, vaccines, dental care and regular checkups. These children are also at greater risk for developmental delays and infant mortality, Davis said.

But even in the highest-ranking states, quality of care falls short of goals, the report noted. In Massachusetts, the top-ranked state in quality, 75 percent of the children were seen by a doctor and a dentist in the past year, compared with only 46 percent of children in Idaho.

The conclusions reached by Davis, as related by Mr. Reinberg, are that states that do a better job of insuring their children, particularly those of low income, are among the most highly ranked overall for quality of care in the report.

For those who do not have the time or desire to dig into the actual report itself, Mr. Reinberg does a fine job of communicating the high points. The rest of his article covers comparisons of the highest and lowest ranking states, the concept of the "medical home," and more. Once again we find that the actual statistics of the current crisis in care are disheartening, but defining a problem is the first step towards rectifying it.

Continued studies such as these will help us to refine our focus on what areas need to change and how to properly go about it. We can create a system of universal care in this country. To paraphrase a line from an old television show, "We can rebuild it, make it better than it was. Better. Stronger. Faster."

SOURCE: "AStates' Scorecard Finds Big Differences in Kids' Health Care" 05/28/08
photo courtesy of M@rg, used under its Creative Commons license

Health News for the Holidays

While we were off enjoying the yuletide holidays the world of health care did not sit still. Since it has been a few days since we've been able to provide you with informative reading material, it is time for another quick roundup of some interesting and important stories from the past few days.

First stop: Melville, New York. Kathleen Kerr over at Newsday brings us tidings of the decade-old MDNY Healthcare, an HMO, which has just announced that it is going out of business. As she points out, this is the latest in a string of ill news for the group:

In 1999, the insurance plan announced its withdrawal from the western New York marketplace, citing steep operating costs and $1 million in losses. A year later, MDNY was among 21 health insurers fined by the state Insurance Department for failure to pay claims promptly - the company paid $5,000.

Next comes a brilliant bit of holiday marketing from Highmark (you might remember that we wrote about these guys awhile ago) as they offer their new health care gift cards to the first newborns of the year in the company's home state of Pennsylvania (News Release). Notable is the fact that nowhere in their news release does it specify how many of the state's newborns will be gifted with the cards.

No news roundup would be complete without taking a quick glance at the contenders for U. S. President. In this arena the Democrats are still the ones dominating the news, mostly due to the growing venom between Democratic frontrunners Hillary Clinton and Barack Obama. If you have been reading our posts here on Health Care Reform Now! you will find no surprises. To mandate or not to mandate, that is the question.

David Nitikin's article for the Baltimore Sun brings us a nice breakdown of the mandate issue along with the the latest (familiar sounding) quotes:

Clinton mailed a letter to Iowa voters, over the signature of former Gov. Tom Vilsack, which says "Mr. Obama threw back talking points worthy of Rudy Giuliani or Mitt Romney" when questioned about "flaws" in his plan.

In response, Obama distributed a piece in New Hampshire that defended his health proposals and urged voters to "remind Hillary Clinton" that the Jan. 8 primary "won't be won by launching misleading, negative attacks."

SCHIP continues to be in the news over the holidays. Conservative blogger Jeff Emanual (Director of RedState.com, a widely read right wing blog) waxes almost gleeful at the defeat of the Democrat driven initiative to expand the program. This morning he shares that glee in a piece on HumanEvents.com:

Even more impressive than the majority party’s public surrender on SCHIP expansion was the speed and completeness of it. Less than a week after falling victim to Bush’s veto pen for a second time, the Senate had passed the fifteen-month extension by unanimous consent, and the House had approved it by a 411-3 vote.

The hysterical tenor of some floor speeches showed the Democrats’ desperation. “How many children will be dead” if the President were to veto the SCHIP expansion? asked Rep. Lloyd Doggett (D-TX).

Last, but very far from least is the ongoing saga of California's struggle to enact health care reforms. Rather than point you toward a single article, here is a link to the Google News results page on the subject. A wide variety of opinions and perspectives for your home researching pleasure.


SOURCE: "Melville HMO going out of business" 12/26/07
SOURCE: "Press Release: Highmark to Present State's Newest Residents with Healthcare Gift Cards " 12/24/07
SOURCE: "Clinton, Obama clashing on health
Democrats debate requiring people to buy coverage" 12/26/07
SOURCE: "SCHIP Expansion: Congressional Majority Surrenders Completely" 12/26/07
SOURCE: "Google News: California Health Care" 12/26/07
photo courtesy of bobcat rock, used under this Creative Commons license

California Prepares to Drop Coverage for Kids

The effects of President Bush's recent SCHIP veto are becoming visible in California, where state officials met Monday to prepare for the loss in funding. Anthony Wright, Executive Director of Health Access California, analyzes the ripple effect in a column for the California Progress Report:

In the wake of President Bush's veto of SCHIP and the stalemate over the reauthorization of the federal children's coverage program, board members of California's Managed Risk Medical Insurance Board (MRMIB) on Monday took the first step that would enable the state to put children eligible for Healthy Families on a waitlist, or begin disenrolling eligible children from the program altogether.

Emergency Regulations adopted on Monday can be found here. Healthy Families enrolls approximately 830,000 children in families with incomes between 100% and 250% of the federal poverty level ($20,650 to $51,625 for a family of four).

According to Wright's article the MRMIB's Executive Director, Lesley Cummings, first brought this idea to the table after President Bush's initial veto of the SCHIP legislation. According to Cummings, if the program continued to operate normally Healthy Families would run dry of funding and have to shut down from July through September of 2008.

She and other board members emphasized, ad nauseum, that Monday's adoption of emergency regulations did not necessarily mean that waitlists would be established or children would lose coverage.

Advocates, including Wright's own organization, Health Access California, argued against enacting the emergency regulations at this time. Representatives of 100% Campaign, Community Health Councils, Inc. and other groups were also present to speak against the emergency regulations.

However, after minimal discussion, the chair moved and the board voted to approve the emergency regulations. They did adopt one additional provision to revise the proposed regulation to reinstate previously enrolled children first, before new applicants, when funding was ultimately reauthorized.

The net result is that the waitlisting and disenrollment procedures can start as early as December 5th, 2007 -- less than one month from today. Mr. Wright's column has further details on the board meeting and the mechanics of the waitlisting and disenrolling procedures.


SOURCE: "California Takes First Step Towards Disenrolling Children from Health Coverage Because of Bush Veto of SCHIP" 11/06/07
photo courtesy of Mosseby, used under this Creative Commons

One Third of Americans Call for Health System Rebuild While SCHIP Faces New Veto

Thursday the SCHIP legislation cleared the senate by a vote of 64-30, still not enough to override the promised veto from the executive branch. This would be President Bush's second veto of this legislation.

The Associated Press analysis of the situation yields the following:

In a situation of bewildering political complexity, Republicans dictated the decision to pass the legislation speedily. It appeared their goal was to short-circuit attempts by supporters of the bill to reach a compromise that could attract enough votes in the House to override Bush's veto.

Attempts by [U.S. Senator Harry] Reid to delay final passage of the bill until next week or longer drew objections from the Republicans.

This new round in the ongoing SCHIP battle comes as Science News brings us the results of a new seven nation study by the Commonwealth Fund, showing that over one third of Americans want a total rebuild of our health care system from the ground up. This is the highest rate of any of the countries surveyed, and cites medical errors, costs, and long waits for treatment as major contributing factors.

As in previous surveys, U.S. adults were most likely to have gone without care because of cost and to have high out-of-pocket costs. In the U.S., nearly two of five (37%) of all adults and 42% of those with chronic conditions had skipped medications, not seen a doctor when sick, or foregone recommended care in the past year because of costs -- rates well above all other countries. In contrast to the U.S., patients in Canada, the Netherlands, and the U.K. rarely report having to forgo needed medical care because of costs.

In addition, one-fifth of U.S. adults report serious problems paying medical bills--more than double the rate in the next highest country. And nearly one third (30%) in the U.S. spent more than $1,000 in the past year out-of-pocket -- a level rare in most of the other countries.

Some additional statistics provided from the report include:

• 1 in 5 report doctors advising treatment perceived as having little to no benefit


• Only in the Netherlands do people spend more time on paperwork and medical bill/insurance disputes


• The U.S. has the second highest percentage of adult visits to the emergency room (36%) out of nations surveyed, exceeded only by Canada.

SOURCE: "Congress Passes New Child Health Care Bill, Setting Up Another Veto Fight With Bush" 11/02/07
SOURCE: "One Third of U.S. Adults call For Completely Rebuilding Health Care System" 11/04/07
remixed photo courtesy of James and Vilija, used under this Creative Commons license

Veto II: The Sequel?

On Thursday the U.S. House of Representatives passed a revised version of the SCHIP legislation that President Bush vetoed the last time it came through Congress. The final tally was 256-142, enough to pass but shy of the two thirds majority needed to override another veto. (Ten members of the California delegation did not vote due to the wildfires in their home districts.)

While the Democrats refuse to alter the scope of the proposed plan (covering 10 million children at a cost of $35 billion over five years), there are a number of alterations when compared to the previously vetoed attempt. Matt Canham at the Salt Lake Tribune enumerates some of the changes:

The latest bill would:

• Cap income eligibility at three times the poverty level or about $60,000 a year for a family of four. The old bill would allow the president to agree to waivers to cover those making more than that.


• Phase out the adults covered by CHIP in one year instead of two.


• Require the Social Security Administration to verify that all participants are citizens, bolstering provisions barring undocumented immigrants.


• Require the Government Accountability Office to create a report detailing the best ways to avoid "crowd out," where those with private insurance drop it in favor of this government program.

The White House and House Republicans were not impressed by the concessions, calling them "cosmetic."

Depending on how long it takes for this revised bill to negotiate the Senate it could be on the President's desk as early as next week. Several media sources report administration officials as saying President Bush is solidly opposed to the stiff increases in tobacco taxes which would fund the program. Most of these sources agree that a second veto is highly likely once this reaches the executive branch. If that occurs an override vote is likely to occur near November 16, the date on which temporary funding for the program expires.

Stay tuned.


SOURCE: "CHIP Revision Passes House" 10/26/07
photo courtesy of Superturtle on Flickr, used and remixed under this Creative Commons license. Image Remix by George Williams

Attempt to Overturn SCHIP Veto Goes Up In Smoke

President Bush's veto stands. After a long and acrimonious war of words the results are now in. Williams Neikirk, a senior correspondent for The Chicago Tribune recounts the closing round of the current congressional battle:

The measure fell 13 votes short of the two-thirds requirement to override the veto. The vote was 273-156, as 54 Republicans voted with Democrats to pass the bill, compared with 53 GOP members who voted for the bill when it first passed. Only two Democrats voted to sustain the veto compared with six who voted against the bill originally....

The bill killed Thursday would have cost an additional $35 billion over the next five years and made children's health-care insurance available to more middle-class families. The expansion would have been financed with a 61-cent-a-pack increase in the federal tobacco tax, raising the levy to $1 a pack.

John Godfrey of Dow Jones Newswire gives us some specifics about the tax on CNNMoney:

Companies that would have been affected include R.J. Reynolds Tobacco Co., a wholly owned operating subsidiary of Reynolds American Inc. (RAI); Philip Morris USA, a subsidiary of Altria Group (MO); and Carolina Group (CG), which is a unit of Loews Corp. (LTR).

The $35 billion raised by the tobacco tax increase over five years would have offset the cost of expanding the State Children's Health Insurance Program. The bill's supporters said that by 2012, the expansion would have allowed the program to cover nearly 10 million children.

House Speaker Nancy Pelosi, D-Calif., already has promised to have the same bill back on Bush's desk within two weeks. Asked whether the bill might include an alternative funding source, Pelosi said simply, "no."

Smoking and health, two subjects often found intertwined. It is interesting to note how little this aspect of the legislation has been touched upon over the last few weeks of constant media coverage. To some it is not only a very relevant concern, but also an emotionally charged issue.

Take the following excerpt from a letter to the Yale Daily News by Jose Abrego, a student in the Ezra Stiles College, as an example:

Consider the ramifications of raising the tax on tobacco by such a ridiculous rate. Nearly all of the tobacco farmers in my province in the Dominican Republic would have their contracts frozen. The same goes for other countries in Latin America.

What worries me about this whole issue is that the tax increase guaranteed that hundreds of thousands of farmers across Latin America would suddenly find themselves unemployed. For Third World nations that are already neck-deep in a sea of poverty, this bill promised to drown them outright. Why didn't any of the major news networks report on the number of jobs that Bush saved in Latin America? Or the number of children that will continue to eat because their parents are employed? Isn't the media's job to present the news to us impartially - or at least pretend to do so?

SOURCE: "House Fails to Foil Health-Care Veto: Defiant Democrats Vow Revised Bill" 10/19/07
SOURCE: "House Failure to Override Veto Good News for Tobacco" 10/18/07
SOURCE: "Letter: Media Ignores Benefits of Health Care Veto" 10/18/07
photo courtesy of SuperFantastic on Flickr, used under this Creative Commons license

SCHIP, The Frosts and Catholics United

October 18 is fast approaching. On that day, once the Senate votes are counted, we will know whether or not the President's veto of SCHIP will stand. As is hardly shocking, the rhetoric and campaigning will continue to escalate between now and then.

A quick sampling unearths the following news items related to this piece of legislation.

As noted in one of my recent posts, the conservative blogosphere has been in attack mode ever since the airing of Graeme Frost's pro-SCHIP radio address. As The Wall Street Journal notes, this approach seems to have backfired:

That narrative was bolstered this week by some conservative bloggers. After the Schip veto, Democrats chose a 12-year-old boy named Graeme Frost to deliver a two-minute rebuttal. While that was a political stunt, the Washington habit of employing "poster children" is hardly new. But the Internet mob leapt to some dubious conclusions and claimed the Frost kids shouldn't have been on Schip in the first place.

As it turns out, they belonged to just the sort of family that a modest Schip is supposed to help. One lesson from this meltdown is the limit of argument by anecdote. The larger point concerns policy assumptions. Everyone concedes it is hard for some lower-income families like the Frosts to find affordable private health coverage. The debate is over what the government should do about it.

Sheila Suess Kennnedy, associate professor of law and public policy at the Indiana University School of Public and Environmental Affairs in Indianapolis, corrects the President's facts in the Indianapolis Star:

We can discount the inartful and downright inaccurate descriptions of the bill coming from the White House. In a press conference, Bush complained that the bill wasn't really focused on the poor -- that it would cover children whose families earned up to $83,000 a year. Several senators, including Charles Grassley, a Republican sponsor of the legislation, were quick to correct him.

The bill maintains current law, and limits the program to children whose families earn up to twice the federal poverty level. That would be $41,300 for a family of four.

Daily Kos also notes an unexpected twist to the debate as a segment of the pro-life movement gets involved in supporting the progressive stance:

Catholics United will launch a radio advertising campaign targeting ten members of Congress whose opposition to the State Children's Health Insurance Program (SCHIP) have compromised their pro-life voting records.

The ads, which feature a mother urging her Congressional Representative to support SCHIP, will primarily air on Christian and talk radio stations from Monday Oct. 15 to Wednesday, Oct. 17 as Congress approaches a critical Oct. 18 vote to override President Bush's veto of bipartisan SCHIP legislation.

[...]

The script for the radio commercial reads: "I'm the mother of three children, and I'm pro-life. I believe that protecting the lives our children must be our nation's number one moral priority. That's why I'm concerned that Congressman X says he's pro-life but votes against health care for poor children. That's not pro-life. That's not pro-family. Tell Congressman X to vote for health care for children. Call him today at XXXX, that's XXXXX."

We will try to keep you informed on the latest news on this subject between now and the October 18 vote.

SOURCE: "SCHIP Howlers" 10/13/07
SOURCE: "Veto Sends Message About Priorities" 10/15/07
SOURCE: "SCHIP Stories: Republican's Getting Grief From All Angles" 10/11/07
photo courtesy of Tony Wan Kenobi on Flickr under this Creative Commons license

Politics Over Productivity

Children's health care is a subject we cannot get away from, especially recently. The SCHIP legislation and President Bush's veto are impossible to escape when one surveys the morning news. Vitriol pours from both sides of the issue as thick and bitter as service station coffee.

As one digs through the multitude of vituperative articles, blog posts, and paid propaganda, it becomes more and more apparent that most of the discussion is politics rather than objective analysis. The Democrats are now experiencing the backlash from their recent radio campaign. In that campaign, Graeme Frost, age 12, made a radio address asking President Bush to sign off on the SCHIP legislation on the grounds that he and his siblings would not have received hospital care after their auto accident without it.

From the Baltimore Sun

But while the Frosts were helping a bipartisan majority in Congress sell a plan to expand the program, they were not prepared for comments such as this one, posted over the weekend on the conservative Web site Redstate:

"If federal funds were required [they] could die for all I care. Let the parents get second jobs, let their state foot the bill or let them seek help from private charities. ... I would hire a team of PIs and find out exactly how much there parents made and where they spent every nickel. Then I'd do everything possible to destroy their lives with that info."

The arguments continue, as chronicled in the Baltimore Sun, over the state of the Frost family's finances and their reliance on SCHIP. Rush Limbaugh discussed the family's assets and financial status on his show last Monday, while conservative blogger Michelle Malkin posted about visiting the family's business and driving by their home.

Quotes such as this one (again from Redstate) seem par for the course:

"Hang 'em. Publicly," the contributor wrote. "Let 'em twist in the wind and be eaten by ravens. Then maybe the bunch of socialist patsies will think twice."

You do not have to be an advocate of public hangings or destroying lives to make your point. The Atlanta Journal-Constitution is a fine example:

Are the Democrats grandstanding? Are they playing politics with a critical issue? Of course, they are. When don't politicians play politics? But at least they're blanketing the airwaves and blitzing the phone lines with an issue that matters — health care for children of working families.

It's a little vexing to listen to ultraconservative Republicans berate Democrats for trying to score political points. For the past several years, the GOP has made a fine art of scoring points over issues both petty and private: for example, the overblown travel office "scandal" during the Clinton years; for another, the intrusion into the difficult decisions faced by the family of Terri Schiavo. They've exploited flag-burning, same-sex marriage and religious faith, all to gain political advantage. It seems a bit churlish for them to complain when the tables are turned.

And so the debate rages on.

SOURCE: "Frost Family Draws Ire of Conservatives" 10/10/07
SOURCE: "Democrats Politicking for Good Reason: Peach Care" 10/10/07
photo courtesy of Graniers on Flickr, used under this Creative Commons license

The Veto Heard Round The World

President George W. Bush on Wednesday issued his expected veto of $35 Billion in children's health care funding. In short order the commentary and criticism of this move have rippled through not only our own national news, but across the the global media as well. Here is a quick World Tour of reactions to this fourth veto of President Bush's career:

The first stop on our world tour is Korea, where we pick up a copy of The Korea Times and read about the SCHIP legislation:

The bill has problems. It is expensive, $35 billion over five years; the use of a cigarette tax to finance it is questionable; and it may indeed cover some families who could afford private insurance.

But it is not, as some overheated opponents charge, socialized medicine or anything like it. Some Republicans charge that SCHIP is the first step toward "HillaryCare," but even if that were in the back of the Democratic candidate's mind, it would be beside the point.

Then we head over to nearby China to see what The Xinhua News Agency has to say:

The veto of Bush was seen by analysts as a high-risk gamble that might impair his party's efforts to compete with democrats for the next presidency and the dominance in Congress.

Lets shift perspective to Western Europe, how are they viewing this? A quick glance at The Economist (UK Edition) unearths the following:

Up with children, down with smokers: it was, in other words, an easy sell. But Mr Bush balked for several reasons. He said that expansion would mean shifting the programme's focus away from poor children. Better off parents might be tempted to drop their private coverage in lieu of the government option, nudging the country down the dangerous road to nationalised care. Mr Bush objected to the tax increase. And although this White House is not known for fiscal restraint, it thought the expansion would cost too much. Mr Bush had previously said that a $5 billion spending increase would be about right.

Getting a bit closer to home we find the Dominican Republic rejoicing at the veto. Why? As Dominican Today reports, it has saved their industry:

Tobacco farmers of the country's north region (Cibao) yesterday heard with joy the news that U.S. president George Bush's vetoed a bill passed by Congress, which threatened to decimate the Dominican and Central American tobacco industries.

The president of the Cibao Tobacco Harvesters Federation, Jorge Mercado, said the U.S. president's decision would reactivate the north zone's tobacco industry, mainly in Santiago province. "The veto of the law represents hope and relief for more than 300 harvesters in this region who have lived off the production of tobacco for centuries."

Agriculture minister Salvador Jiménez, quoted by the newspaper Diario Libre, said if the bill had been signed into law the country would've lost some 54,000 jobs.

Stay tuned.

SOURCE: "Veto of Child Health Bill" 10/04/07
SOURCE: "Bipartisan Tension Tightens as Bush Vetoes Program" 10/04/07
SOURCE: "Why Did George Bush Veto a Popular Health Care Bill?" 10/04/07
SOURCE: "Bush Veto Saves The Dominican Tobacco Industry" 10/04/07
photo courtesy of Bluedharma used under this Creative Commons license

Lilly CEO Calls for Reform and EMRs

While the health care reform community is focused on President George W. Bush’s imminent veto of the children's health insurance bill, a major announcement about Electronic Medical Records (EMRs) has evaded the spotlight.

Sidney Taurel, CEO of pharmaceutical giant Eli Lilly put forth a call for development of a health information technology system. His proposed system would be a collaborative effort of both public and private sectors and would involve the U.S. government, the health care industry and the medical community as active participants.

The aim is tracking both actual effectiveness and side effects of drugs that have been released into the market. This "real world" data will enhance the safety profile of drugs first established through standard drug trials.

CNNMoney reports on Taurel's address at the Cleveland Clinic:

Although traditional drug trials will continue to test new hypotheses about medicines after they have reached the market, Taurel outlined how a well-functioning health IT system could serve not only to frame hypotheses for so-called "Phase IV" clinical research, but also become the practical equivalent of massive, real-world trials. Such a system would collect detailed data from day-to-day medical practices and feed insights quickly, seamlessly and at a lower cost to doctors, regulators, and drug manufacturers. The result would be a more accurate picture of a drug's safety and efficacy than exists today.

Once again we see the importance of developing portable, transparent records as Kaiser-Permanente CEO George Halvorson outlines in his book, Health Care Reform Now!

The CNNMoney article goes on to describe the current collaboration along these lines:

Taurel explained that as EMR systems build out, they provide what amounts to a 'commons' in which organizations can collaborate to share health information.

For example, Lilly, Pfizer, and Johnson & Johnson are collaborating with 'e-Health Initiative' - a not-for-profit health information technology group - as well as with the Indiana Health Information Exchange and the Partners Healthcare System in Boston. The goal is to test how safety signals can be located and understood using existing data, potentially leading to a better understanding of the risk and benefits of medicines.

SOURCE: "Lilly’s CEO Calls For Reform of Nation’s Drug Safety System" 10/02/07
photo courtesy of Uh…Bob

Eight States to Sue Administration Over Child Health Care

As the time approaches for President Bush to veto the current SCHIP legislation, as he has repeatedly promised, the adversarial nature of the debate is turning litigious. Tom Hester at Newsday reports:

New Jersey on Monday joined seven states in filing separate lawsuits against the Bush administration's challenge of proposed federal rules the states say will force poor children to lose health coverage.

The lawsuit for New Jersey was filed Monday morning in federal court in Trenton, state Attorney General Anne Milgram said. New Jersey joins Maryland, Arizona, California, Illinois, New Hampshire, New York and Washington in filing similar litigation.

"The Bush administration has gone beyond its regulatory rights," New Jersey Gov. Jon S. Corzine said as he announced the lawsuit at an East Orange health center.

At the core of the conflict are rules issued by the Center for Medicare and Medicaid Services which the suits claim exceed the statutory authority set forth in Title XXI of the Social Security Act. The SCHIP legislation currently facing veto would remove these new strictures. What new strictures, you ask? Ralph Thomas at the Seattle Times brings us the following clarification:

Under the restrictions, before states can start enrolling kids above 250 percent of the poverty level, they must make sure they are covering at least 95 percent of kids at or below 200 percent of the poverty level.

[Washington State Governor] Gregoire said no state has been able to reach that mark. She said Washington has one of the nation's highest coverage rates, at about 91 percent.

"We just do not believe that is achievable and in fact was put in place to guarantee that we couldn't go above 250 percent of poverty," she said.

The restrictions also require new enrollees above 250 percent of the poverty level to go a year without insurance before they could enroll in SCHIP.

These strictures are being cast as beyond the legal limitations on federal power, and more states continue to bring suit agaisnt them.

"The federal government lacks the authority to do what it is trying to do," [NJ Attorney General] Milgram said, adding that New Jersey's plan has been approved eight times, including five times by the Bush administration.

[New Jersey Gov. Jon S.] Corzine has said the rules could risk health insurance coverage for 10,000 New Jersey poor children.

SOURCE: "8 States Sue Bush Over Children's Health Insurance" 10/01/07
SOURCE: "State to Sue Feds Over Childrens Health Insurance" 10/02/07
photo courtesy of Scott Ableman

Deadlines Loom for Health Care Legislation

In Washington D.C., where the fiscal year ends on Sunday, September 30, President George W. Bush continues to threaten a veto of the State Children’s Health Insurance Program (SCHIP), while Democrats line up votes. Passage is expected in the U.S. House of Representatives early this week and in the U.S. Senate by the end of the week.

In an article for the Monday The New York Times blog, "The Caucus," journalist Carl Hulse explains why Democrats are not backing away from a showdown with the President:

Democrats like their position on this issue. They believe that the public supports making health insurance more affordable and that many families with middle-class incomes are struggling to provide coverage and care for their children. Some Republicans in both the House and Senate are expected to support the plan.

In California, compromise -- not confrontation -- is the top story. The San Francisco Chronicle reports that Governor Arnold Schwarzenegger is close to a compromise with Democratic leaders on a health care reform bill. Schwarzenegger wants to pass the bill before the end of the special legislative session. In a Sunday article outlining the financial interests of a dozen key players, Chronicle journalist Tom Chorneau comments on the surprising civility of the public debate at this late stage:

Absent from the airwaves are the attack ads from insurance companies and doctor groups that many feared would have materialized by now. Massive protests from labor unions or consumer groups intended to push the talks one direction or another have also been largely put on hold.

This should be an exciting week of twists and turns in the effort to pass health care reform legislation. Do you think the California bill or the federal SCHIP program will pass? Do you think President Bush will really veto SCHIP? Do you think the U.S. Congress will have the votes to override a presidential veto? We'd love to hear your comments.


SOURCE: "Democratic Leaders Close to Deal on Health Care Reform," Tom Chorneau, San Francisco Chronicle, 09/23/07
SOURCE: "Congress Tackles Child Health Care," by Carl Hulse, The Caucus, Political Blogging from The New York Times, 09/24/07
photo courtesy of U.S. White House

Let The SCHIPs Fall Where They May

The State Child Health Care Insurance Program (SCHIP) is a major bone of contention between President Bush and the United States Senate. There is never a lack of strident debate when it comes to issues as polarizing as health care has become. Sources large and small are weighing in on the subject everywhere from major networks to the blogosphere.

Political correspondent John Fout talks about SCHIP and examines the brewing confrontation for The Street in his Market Features column:

The program provides coverage to poor children who are ineligible for coverage under Medicare and who lack private health insurance, and according to a Senate report, it's been a big success. According to the report, the number of uninsured children has decreased from 14% in 1997 to about 9% in 2005, bucking the opposite trend for adults.

Fout then proceeds to examine both the funding source for the new expansion and the President's rationale for his threatened veto:

The expansion of the SCHIP program would be funded by a small tax increase on cigarettes. A recent poll by the American Medical Association found that 70% of Americans support a tax hike to pay for children's health care. In addition, incremental increases in cigarette prices are thought to have played a role in decreases in smoking. This sounds like a win-win situation for public health.

Bush, however, prefers to fight expansion of the program. He favors funding care for poor children only -- rather than the lower- or middle-class families who'd be covered under the Senate bill -- and suggested that expansion would cause middle-class families to cancel private policies in favor of public policies. The expansion only affects people presently lacking coverage.

President Bush went on to characterize the bill as "federalization" of health care and to accuse Democrats of using the issue "to score political points." He has also promised to veto the bill once it reaches his desk. (As pointed out in our Aug. 3 post, it passed the Senate with a 68-31 margin -- sufficient to override a veto.)

SOURCE: "Bush Fights Losing Battle Over Kids' Health Care" 09/20/07
photo courtesy of Tenuda on Flickr

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