The stakes in the S-Chip fight
PRESIDENT BUSH, who has engineered the tax code so that it favors the wealthy, is waging one of the last domestic policy campaigns of his presidency against a program that is helping children in families who are just getting by financially. What does he have to fear? Perhaps it is the prospect that the expansion of the State Children's Health Insurance Program (S-Chip) will show the American people that carefully targeted government initiatives make life better for people who weren't helped much by the tax cuts.
In Arkansas this week, in front of a sign that read "fiscal responsibility," Bush defended his veto of the S-Chip expansion as intended to thwart a "nationalization of medicine." But S-Chip is hardly socialized medicine. Largely relying on private insurance, the program has for the past 10 years financed healthcare for children in families that make too much for Medicaid but are too strapped to afford health insurance. Children go to their own doctor, or a health center, or a hospital, just like anyone else with health insurance.
"The bill sent to me said, 'we can expand eligibility for the program up to $83,000,' " Bush contended. Senators Chuck Grassley of Iowa and Pat Roberts of Kansas, Republican supporters of S-Chip expansion, offered an effective rebuttal. They explained in a letter that the bill, just like the S-Chip law that expired last month, is aimed at children in low-income families just above the Medicaid threshold, which varies from $13,690 to $34,570, depending on family size. States can seek to expand income eligibility, but the secretary of health and human services makes the final determination. In August, Secretary Michael Leavitt, a Bush appointee, rejected New York state's proposal to raise the income limit to $82,600 for a family of four.
"Somebody wants to extend the reach of the federal government into medicine," Bush said. That issue has already been decided. The federal government directly controls one-third of healthcare spending in the United States, and much more if the tax deductions for employer-based health insurance are included. The question is how this power will be exercised. Bush favors expansion of health savings accounts and tax deductions for private insurance, both of which offer the most advantages to wealthier Americans. When it comes to children, however, a bipartisan majority in Congress favors a direct approach, through an expansion of S-Chip. The House is scheduled to vote on overriding Bush's veto tomorrow.
The original S-Chip law provided insurance for 6.6 million young people. The expansion plan would extend coverage to millions more. At its core, the S-Chip controversy is all about the purpose of government - should it help those who have the most or should it offer health insurance, an essential of modern life, to people starting out in life who lack the cushion of wealth? 