By Chris Fitzsimon
As many as nine million children in the United States may not be covered by a health insurance plan and more than 250,000 of them live in North Carolina.
Many of the children are eligible for state and federal programs like Medicaid and Health Choice, North Carolina’s program to insure kids in families with incomes up to 200 percent of the federal poverty level, just over $41,000 for a family of four.
Health Choice is North Carolina’s version of the State Children’s Health Care Program (SCHIP) passed in 1997 by the Republican Congress and signed by President Bill Clinton. It allows each state to design its own program and set eligibility limits within broad guidelines established by Congress.
SCHIP expires in September and both the House and Senate have passed new versions of the program that would increase funding to cover more children.
The Senate would allow states to cover children in families with incomes up to 300 percent of the poverty level. The House would remove the eligibility cap and leave it up to states entirely.
The program currently restricts states to providing coverage for children in families who earn up to 200 percent of the poverty level, but the federal government has issued waivers to many states allowing them to expand coverage to families with higher incomes.
President Bush has threatened to veto the House and Senate plans to renew the program, claiming they cost too much and would result in SCHIP replacing private insurance for many families.
Late last Friday, the administration announced rules for the program that include restrictions that make it unlikely any state could offer health coverage for children in families who earn above 250 percent of the poverty level.
That not only adds a new contentious wrinkle to the congressional debate, it may threaten Kids’ Care, legislation passed this year by the General Assembly that would set up a program to cover children in families who earn up to 300 percent of the poverty level by allowing them to purchase coverage on a sliding scale based on income.
In other words, the new guidelines would make it more difficult for thousands of children in North Carolina to see a doctor.
The administration is using the same arguments made against Kids’ Care in Raleigh, the same arguments used to oppose the creation of Health Choice nearly a decade ago. The idea is that expanding public health care programs will entice large numbers of people to drop their private plans to enroll in the public program.
The expansion of SCHIP is also portrayed as a step toward universal health care coverage, or “socialized medicine,†which is absurd, but is effective rhetoric in some circles. The administration and the market fundamentalists prefer tax credits for health care, never explaining how that is supposed to help people who don’t make enough to pay for health care in the first place.
Much of the rhetoric from the administration and their think tank supporters in North Carolina is based on research done by M.I.T economist Jonathan Gruber, who found that roughly a third of the new children who would be covered by expanding SCHIP already have coverage. That is referred to as crowding out of the private market.
Less publicized is Gruber’s conclusion that 77 percent of the benefits from the tax credit plan proposed by the administration would end up with people already insured. Gruber also says that expanding public health programs makes more sense.
The bottom line is that 264,000 children in North Carolina have no health care coverage and in most cases it is because their families simply cannot afford to buy it.
Let’s put aside all the market fundamentalism nonsense and esoteric philosophical debates and make sure every child can see a doctor. That has nothing to do with socialism or crowd out or anything else. It just means making sure kids are healthy, and it is the least we can do as a civilized state.