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Everybody gets health care in this country. But if you can't afford insurance, you often have to wait until you are sick enough to qualify for a hospital emergency room where they have to treat you.
If you can't afford your bill, the hospital has to make up the money by raising fees for those who can pay. As a result, insurance premiums go up, insurance becomes less affordable, and more people delay seeing a doctor until their health has seriously deteriorated and, accordingly, will be more costly to treat.
Understandably, as free people, most Americans reject the idea that the government should take over medical care and tell everybody where and how to get treatment. But there is broad agreement that the poorest Americans need help, which is why we have the Medicaid program.
But what about families with incomes too high for Medicaid but too low to afford private coverage? Parents have a responsibility for their children, but if private insurance is truly out of their reach, very few people these days say the kids should go without care until a health crisis brings them to an ER.
That's why, in August 1997, the Republican-led Congress created the State Children's Health Insurance Program (SCHIP), a targeted matching grant program designed to provide health care coverage for low-income children of working families. Within guidelines, the states each design their own programs to help provide coverage for those in need.
In Wisconsin, Gov. Tommy Thompson championed the BadgerCare program, which was approved by a Republican-controlled Assembly and a Democratic-controlled State Senate. With the help of a federal waiver giving the state greater leeway for implementation, BadgerCare combines Medicaid and SCHIP in order to make it easier for families to work their way off welfare.
Gov. Thompson understood that if the state cuts off health insurance as soon as families start making progress in the world of work, people can find that improving skills, getting a better job or working longer hours actually makes them worse off. This is a phenomenon known as the "poverty trap," which is a serious concern when trying to figure out how to give needy citizens enough aid to help them without deadening the incentives for the poor ultimately to take control of their lives.
With SCHIP up for revision this year, President Bush suggested adding $5 billion to the program over five years. Unfortunately, due to rising health care costs and the need to extend aid to the six million children who currently qualify but aren't receiving support, such an increase would be too little to maintain even current levels of coverage.
Instead, the Democrats in the House won passage of legislation that would have dramatically changed eligibility limits as well as adding $50 billion. I thought that was too much, so I voted against it.
When considering SCHIP in the Senate, Democrats and Republicans sat down and negotiated. Sen. Chuck Grassley, a strong, conservative Republican from Iowa, won concessions from the Democratic majority, and reduced the increase to $35 billion. He was supported in this by conservative Senators Kit Bond (R-MO), Bob Corker (R-TN), Orrin Hatch (R-UT), Kay Bailey Hutchison (R-TX), Dick Lugar (R-IN), Pat Roberts (R-KS) and John Sununu (R-NH) among others.
Under the compromise, SCHIP would refocus on low-income uninsured children. It would require states to cover the lowest-income kids before extending coverage to any other uninsured children. It would reduce the federal contribution for parents currently participating in the program, and would block new state requests to extend insurance to adults.
Critics have repeatedly implied that the compromise would somehow make SCHIP funding available for families earning up to $83,000. Doing that would require a federal waiver under the current program, and the only change in the compromise is one that makes such waivers virtually impossible to utilize due to new poor-children-first requirements.
Contrary to charges often heard, the compromise does not make it easier for illegal immigrants to get benefits. Rather, it clearly states that funds cannot go to illegal immigrants. Further, and despite rumors, it does not allow SCHIP funds to cover abortions, and it does not change the definition of a child to age 25. Instead, it takes the necessary steps to ensure that these policies do not and cannot happen.
I thought Sen. Grassley negotiated a good compromise, and I voted for it when the House agreed to substitute the Senate's proposal instead of the more expensive version it had previously approved. I regret that President Bush chose to veto it. I think his stance is penny-wise but pound foolish, and has pushed many Republicans to walk the plank without good reason - to take a position that just won't pass muster with the public, much to the Democrats' glee.
While it seems likely that the veto will be sustained, I hope that in the aftermath we can eliminate the partisan rhetoric and all do what is right for the neediest of our children.
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