New York applied to the federal government recently to expand their State Children’s Health Insurance Program to more families, and the request was denied. SCHIP was designed to provide state and federal subsidies to provide health insurance for children in low income families – an admirable project.
Last month, federal guidelines were changed to “refocus the program on the low-income people it was intended to serve.” Changes include rules that require a state to prove that at least 95% of low income (up to 200% of poverty level – or $34,340 for a family of three) children have been enrolled in the program before the state is allowed to expand the program to children from higher income families. Another requirement is that a child be uninsured for at least a year before being eligible for SCHIP. At first glance, this rule seems unconscionable. But the driving force here is to make sure that families are not dropping private health insurance in order to switch to better or cheaper coverage through SCHIP. This one is a tough call. It’s difficult to justify making a truly needy family – say one that loses a job and cannot begin to afford COBRA payments – wait a year for their children to be insured. But there has to be a deterrent to keep families who are capable of paying health insurance premiums – and indeed, have been doing so – from dropping their coverage with the intention of switching to SCHIP.
New York wanted to expand their program to allow children of middle income families – earning up to $68,680 for a family of three – to qualify for SCHIP, and to require only a 6 month uninsured waiting period for a child to be eligible for coverage. But since they could not demonstrate that they have enrolled 95% of children from families earning less than 200% of the poverty level, and since they wanted to shorten the waiting period for eligibility, the federal government rejected their request.
This is a tough debate. I can easily see things from both sides. I don’t think that $68,680 for a family of three should qualify anyone for any sort of public assistance – this is a more than adequate income to cover all of life’s necessities, including health insurance. But I know that there are parents who make between $34 thousand and $68 thousand who might choose not to have health insurance for their child, or – for the ones who are closer to $34 thousand – truly struggle to pay the premiums. And no child should have to go without medical care because of her parents’ irresponsibility or inability to pay health insurance premiums.
It will be interesting to watch this debate play out between the Bush administration and the state of NY. With polar opposite political ideals and very different ideas about how health insurance should be handled in the US, each side will likely put up quite a fight. It’s tough to imagine anyone – regardless of political affiliation – believing that any child should be without health insurance in the US. A child cannot provide for himself when it comes to health care. It’s the responsibility of the parents and/or the government to make sure that children have access to basic necessities – education, food, shelter, safety, and health care. If the parents cannot or will not provide these things – for whatever reason – we cannot just leave the child to fend for himself. But we don’t want to create a system that enables irresponsible behavior on the part of parents who could otherwise afford to pay for health insurance for their children.
Here in Colorado – and across the country – lawmakers will be watching closely the debate in NY. Nearly every state is grappling with health care issues, and it doesn’t appear that there will be any easy fixes.