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Tensions Continue on SCHIP

By Mary Agnes Carey, CQ HealthBeat Associate Editor

February 15, 2008 -- In the weeks following President Bush's second veto of Democrats' legislation to expand the State Children's Health Insurance Program (SCHIP), tensions continue to mount between administration officials, Democrats, and children's groups over funding for children's health care programs.

During a Feb. 13 Senate Finance Committee hearing on Medicare Advantage plans, Sen. John D. Rockefeller IV, D-W.Va., called an Aug. 17 SCHIP guidance the administration issued to state Medicaid offices "a really malevolent directive" because it sidestepped Congress and has placed "great distress" on state officials who cannot meet the requirements. Under the guidance, states have to show they are already insuring 95 percent of children from families earning less than twice the poverty level before expanding SCHIP or Medicaid to cover children from higher-income families.

"It was cynical because you know that it is not possible," Rockefeller complained to acting Centers for Medicare and Medicaid Services administrator Kerry Weems. Rockefeller and other lawmakers have said that CMS had no legal authority to issue the guidance without consulting Congress first. "You do it because no one stands up to you," Rockefeller said. "You cut the legs right out from underneath us."

"We took this action believing we had the legal authority to do so," Weems responded, adding later that "we need to put the poorest children first." When Rockefeller asked later in the hearing if Weems knew how many children had lost coverage due to the Aug. 17 directive, Weems said he did not but added that SCHIP is not the only program where children can receive health care coverage.

Rockefeller then asked if Weems had ever been to West Virginia. When Weems said that he has driven through the state, Rockefeller quipped, "On the way to the Greenbrier?," referring to the resort in White Sulphur Springs. Weems responded that he has never been to the Greenbrier and added that he grew up in Southern New Mexico. In 2006, New Mexico and West Virginia experienced some of the nation's highest poverty rates. Rockefeller told Weems, "You ought to be seeing things differently."

The terse back-and-forth between Rockefeller and Weems shows the ongoing tension between Democrats and the administration in a variety of areas, including Bush's veto of SCHIP legislation. Last month, the House failed by a vote of 260–152 failed to override the veto but seek another vote on SCHIP legislation before the November elections. Bush signed a law late last year that keeps SCHIP running through the end of March 2009 with enough money to maintain coverage at current enrollment levels.

When Bush released his fiscal 2009 budget plan on Feb. 4, critics said the proposal would slash billions in funding from programs vital to children's health, such as Medicaid, graduate medical education for children's hospitals and emergency medical services.

"Sadly, 2009 marks another year where the president has failed to make children a priority in his federal budget," said Bruce Lesley, president of the children's advocacy group First Focus. "From education to health, child safety to child welfare, juvenile justice to tax cuts, the president has cut billions from programs that have direct impacts on America's children and their families."

While Bush's budget for fiscal 2009 contained billions more in SCHIP funding, Leslie and other critics of the White House plan said the money was still not enough to fund services for children currently enrolled in the program.

Office of Management and Budget Spokesman Sean Kevelighan said such criticism was "unsurprisingly misdirected" and that the budget redirects funding into programs that are more effective. On SCHIP, Kevelighan said the budget amount "is the precise funding for the program to continue meeting its original intent, to provide health care for children at 200 percent or below the federal poverty level."

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