WASHINGTON — The modest spending increase that Congress approved for a popular children’s health insurance program will maintain coverage for those already enrolled. But many lacking insurance will have to look elsewhere.
Few expected such a result when 2007 began. Democrats proposed a huge spending increase on the federal-state partnership known as the State Children’s Health Insurance Program. Many Republicans embraced the idea. Meanwhile, states all over the country were drawing up plans to expand health coverage.
A lot of those plans have been scuttled. The spending increase most lawmakers supported has been vetoed twice by President Bush, who balked at the $35 billion price tag and method of payment — a tobacco tax.
“We were all very, very hopeful. Now, we feel like they are farther apart than they were a year ago,” said Cindi Jones, who oversees Virginia’s SCHIP program.
Virginia was one of several states going into the year thinking about expanding eligibility limits for SCHIP. It’s a typical state in that it provides health coverage for families with incomes up to twice the federal poverty level — $34,340 for a family of three. Jones said officials considered moving the eligibility limit to at least $42,925.
“This just didn’t seem like the right time to raise the eligibility with the uncertainty of what’s going on at the federal level,” Jones said.
Lawmakers across the state line in West Virginia approved an expansion that would have raised the eligibility level to $51,510 for a family of three. It’s now at $37,774. The increase would have led to about 4,000 more children getting coverage.
“That potential growth is on hold,” said Sharon L. Carte, who oversees West Virginia’s program.
Some analysts say the number of children getting SCHIP coverage may still decline next year — a bitter prospect for Democrats who promised they would expand enrollment from 6 million children to 10 million.
“We are left with a package that addresses the most immediate concerns, but leaves any real health care improvements for another day,” Rep. Frank Pallone, D-N.J., said during last week’s SCHIP debate. “I think that is very unfortunate.”
GOP lawmakers say they want to work out a compromise. But many are satisfied with the extension the House approved Wednesday. Republican leader John Boehner, R-Ohio, said the extension “provides all the resources necessary to cover low-income children who need quality health insurance.”
Republicans say any expansion should not allow middle-income families to drop private coverage for the public kind. They insisted that SCHIP retain a new Bush administration directive that makes it harder for states to cover middle-income children. Democrats criticized the directive for months. They promised to rescind it, but failed.
The directive said that before states cover higher-income children, they must meet the following threshold: At least 95 percent of children eligible for Medicaid and SCHIP with incomes less than twice the poverty level must be enrolled in those programs.
Many states say meeting that threshold is nearly impossible. But that’s not all the directive said. Even if states meet that threshold, the middle-income children will have to go without private coverage for a full year before they can enroll in SCHIP, and their families will have to pay premiums or co-payments that are 5 percent of their income.
The directive will affect about half the states. Fourteen are already covering children above $42,925 for a family of three and 10 more were planning to do so, says the Center for Children and Families at Georgetown University.
One of those states, California, is considering a proposal that would require all Californians to have health insurance coverage, but a central piece of that proposal also increases the threshold for SCHIP eligibility — from the $42,925 level for a family of three to the $51,510 level.
“We are left with a package that addresses the most immediate concern (for children and their families), but leaves any real health care improvements for another day … that is very unfortunate.”