July 9, 2007
By ROBERT
PEAR
WASHINGTON,
July 8 — The fight over a popular health insurance
program for children is intensifying, with President Bush now leading efforts
to block a major expansion of the program, which is a top priority for
Congressional Democrats.
The seemingly uncontroversial goal of insuring more children has become the
focus of an ideological battle between the White House and Congress. The fight
epitomizes fundamental disagreements over the future of the nation’s health
care system and the role of government.
Democrats have proposed a major expansion of the program, the State
Children’s Health Insurance Program, to cover more youngsters with a
substantial increase in federal spending.
Administration officials have denounced the Democratic proposal as a step
toward government-run health care for all. They said it would speed the erosion
of private insurance coverage. And they oppose two of the main ideas
contemplated by Democrats to finance expanded coverage for children: an
increase in the federal tobacco tax and cuts in Medicare payments to private
insurance companies caring for the elderly.
White House objections to the Democratic plan are “philosophical and ideological,”
said Allan B. Hubbard, assistant to the president for economic policy. In an
interview, he said the Democrats’ proposal would move the nation toward “a
single-payer health care system with rationing and price controls.”
Democrats said the insurance program, created 10
years ago with bipartisan support, had improved access to care for millions of
children and sharply reduced the number who were uninsured. Democratic leaders
in both houses of Congress — with support from doctors, consumer groups and
many state officials — want to increase enrollment in the program, which served
7.4 million people at some time in the last year.
“We expect a showdown on the Senate floor at the end
of this month,” said James P. Manley, a spokesman for the majority leader,
Senator Harry
Reid, Democrat of Nevada. “The program, which has enjoyed broad bipartisan
support, is under assault by right-wing Republicans.”
State officials fear that the conflict in
“I am getting more and more nervous about the future
of the program,” said Judith Arnold, director of the Children’s Health
Insurance Program in
In
Several Republican senators said they would work with the White House to
prevent a major expansion of the program.
John Hart, a spokesman for Senator Tom Coburn, Republican of Oklahoma, said
Mr. Coburn saw the Democratic plan as “part of an effort to bring everyone into
a socialized health care system, a clarion call for Hillary Care, part two,”
referring to the Clinton administration plan for universal coverage. Senator
Jim DeMint, Republican of South Carolina, shared that view.
In a June 28 memorandum, House Democratic leaders said they hoped that
providing coverage for more children would be “the signature Democratic health
achievement” of this Congress. But, they predicted, “The administration will
battle us every step of the way.” The memorandum was sent by Representatives John
D. Dingell of Michigan, Frank Pallone Jr. of New Jersey, Charles
B. Rangel of New York and Pete Stark of California.
Bush administration officials recently advised drug
company executives not to support a major expansion of the program.
The Pharmaceutical Research and Manufacturers of America, a trade group, has
been running television and newspaper advertisements that praise the program
and urge Congress to renew it. The television advertisements show children
cavorting on a playground and singing a jingle, “If you’re healthy and you know
it, clap your hands.”
The drug industry has joined four organizations in a
coalition to whip up support for the program. The coalition, Americans for
Children’s Health, was incorporated last month and has a budget of several
million dollars, mostly for advertising. Directors include lobbyists from the
American Health Care Association, which represents nursing homes; the American Medical Association; Families USA, a liberal-leaning nonprofit consumer group;
and the Federation of American Hospitals, which represents for-profit
hospitals.
Mr. Hubbard said such groups “would be making a huge mistake to support
expansion of the Children’s Health Insurance Program” along the lines proposed
by Democrats.
In an interview, Michael
O. Leavitt, the secretary of health and human services, said he had
conveyed the administration’s concerns to Billy
Tauzin, the president of Pharmaceutical Research and Manufacturers of
America, and Kevin W. Sharer, the chief executive of Amgen and chairman of the
trade association.
The federal government spends $5 billion a year on the children’s insurance
program. If spending continues at that level, it would total $25 billion over five
years. Congress has adopted a budget blueprint providing up to $50 billion
more, for a total of $75 billion over five years. That dwarfs the $5 billion
increase over five years proposed by Mr. Bush in February.
The Congressional
Budget Office estimated that enrollment in the program would “fall to 6.7
million” under the president’s proposal.
In recent days, the Bush administration has taken several steps to slow
momentum for expansion of the program:
The Department
of Health and Human Services has tried to redefine the magnitude of the
problem by issuing a new study that says one million uninsured children are
already eligible for Medicaid or the children’s insurance program. Previous
estimates by private researchers and government experts put the number at more
than 5 million.
Regional directors of the department have sent identical letters to newspapers,
warning against “a government takeover of the health care marketplace.”
Administration officials said Congress should include the president’s
proposal to change the tax treatment of employer-sponsored health benefits as
part of any legislation to renew the children’s insurance program.
In his 2008 budget request, Mr. Bush proposed replacing virtually all of the
current tax breaks for health insurance with a new standard deduction for any
taxpayer who buys a qualifying health plan. House Democratic leaders have
flatly rejected the proposal. Senate Democratic leaders have said it has no
place in a bill to cover children.
To return the children’s insurance program to what he calls “its original
intent,” Mr. Bush has asked Congress to reduce federal payments to the states
for coverage of children in families with incomes of more than twice the
poverty level. (A family of four is considered poor if its annual income is
less than $20,650.) At least 18 states cover children with family incomes more
than twice the poverty level.
In Indiana, Gov. Mitch
Daniels, a Republican who was Mr. Bush’s first budget director, recently
signed a bill into law that raised the ceiling to 300 percent of the poverty
level, from 200 percent.
The New York State Legislature recently approved a proposal by Gov. Eliot
Spitzer, a Democrat, to increase the eligibility limit to 400 percent of
the poverty level.
Mr. Leavitt said it was absurd that “families making over $81,000 a year
would have children eligible for public assistance.”
Mr. Bush and some Republicans in Congress worry that as public coverage
becomes available to families with higher incomes, it tends to replace private
coverage.
In a recent report, the Congressional Budget Office said that for every 100
children who get public coverage as a result of the children’s insurance
program, “there is a corresponding reduction in private coverage of between 25
and 50 children.”
That increases the cost of efforts to expand coverage, according to the
budget office, because the government inevitably picks up some people who
recently had private insurance when it tries to sign up the uninsured. Thus,
the budget office said, to reduce the number of uninsured children by three
million, states may need to add four million to six million children to the
rolls.
Peter R. Orszag, director of the budget office,
said that other efforts to expand coverage — for example, by offering tax
breaks for buying private insurance — faced a similar challenge: some benefits
would go to people who already had coverage.