September 6, 2007
By John S. O'Shea, M.D. and John O’Shea
It's hardly controversial to point out that all children deserve
access to the best available health care, regardless of their
economic circumstances. Unfortunately, if Congress has its way, our
country will actually move further away from that ideal.
Simply put, the House and Senate bills to expand the State
Children's Health Insurance Program, or SCHIP, aren't the way to
improve the quality of health care for low-income children.
In fact, Congress is poised to expand a program that has a track
record of contributing to the overcrowding of hospital emergency
rooms, which is degrading the quality of care for all of us.
We've had 10 years of experience with the program. Created in
1997, SCHIP originally targeted children in families whose earnings
were too high to qualify for Medicaid but less than 200 percent of
the federal poverty level. In today's dollars that's slightly more
than $40,000 annually for a family of four.
Like many other federal programs, SCHIP already has grown far
beyond its original scope.
In 2005, an estimated 45 percent of all children were
covered by Medicaid or SCHIP, compared with 28 percent in 1998.
The House bill would accelerate this expansion by allowing
21-year-olds to be recognized as "children" for purposes of the law
(an earlier version of the House bill would have defined
25-year-olds as "children") and by giving special "bonus payments"
to state officials who hike up SCHIP and Medicaid enrollment. That,
in turn, would crowd out private coverage by expanding SCHIP to
middle- and upper-middle-income kids.
The non-partisan Congressional Budget Office reports that under
the House bill 2.1 million people could be pushed out of private
insurance and into government health care.
Whatever Congress does, it shouldn't erode the private health
insurance that Americans already have, since that coverage provides
access to superior private medicine. Anyone who is concerned about
the quality of medical care individuals and families can receive
should note that the House and Senate bills go in exactly the wrong
After all, we know that those with health insurance coverage
have access to better quality medical care.
One reason is because the uninsured of all age groups often get
care that is delayed, of poorer quality and unnecessarily costly.
Surveys show that as many as 54 percent of children without
coverage have never had an annual checkup and that 30 percent had
no primary pediatrician.
No child should be without affordable quality health care
coverage, but expanding government control of health care is not
the way to achieve that laudable goal.
Since the majority of uninsured children are from families with
annual incomes that are below 200 percent of the federal poverty
level ($41,300 for a family of four), congressional proposals to
raise family income eligibility levels to 300 percent of poverty
($62,000 for a family of four), or more, does not target the
The CBO reports, for example, that 77 percent of children
between 200 percent and 300 percent of the federal poverty level
already have private health insurance.
More importantly, moving people into government health care
programs in the name of providing minimal coverage instead of
expanding their opportunity to get private coverage won't improve
their quality of care.
Medicaid and SCHIP enrollees fair no better than the uninsured
when it comes to having a regular source of well-child and primary
care. Because of that, they often wait and only interact with the
system when they are sicker and require more intensive
In other words, those on Medicaid and SCHIP don't get the timely
and more responsive care available to people with private
Worse, according to the Centers for Disease Control, patients
with Medicaid and SCHIP as their source of payment are twice as
likely as the uninsured and four times as likely as those with
private insurance to visit a hospital emergency room.
These are often people with non-urgent medical conditions that
could - and should - be handled in a more appropriate, less costly
venue, such as a primary care physician's office. Instead, they
crowd into an already overburdened emergency medical system.
Congress should exercise common sense and restore SCHIP to its
original intent. Let's target federal funding to kids in low-income
families, with sensible age and income eligibility requirements,
while removing legal and regulatory barriers to affordable private
This could easily be done through a new system of refundable
health care tax credits or vouchers to low-income families, as well
as direct tax relief to individuals and families, enabling them to
choose the type of coverage that best suits their needs.
Congress should not increase the already hefty health care price
tag faced by American taxpayers and make them fund the expansion of
a government health care program that delivers substandard
John S. O'Shea, MD, MPA, is a practicing physician and a
former Health Policy Fellow at the Heritage Foundation
First appeared in FOXNews.com
It’s hardly controversial to point out that all children deserve access to the best available health care, regardless of their economic circumstances. Unfortunately, if Congress has its way, our country will actually move further away from that ideal.
John S. O'Shea, M.D.
Harvard Graduate Fellow
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