Congress has set aside $16 billion to extend health coverage to some of the estimated 10 million American children who now lack it. Allocating money in these improved economic times to keep children healthy was a relative snap. Deciding just how to spend it is not.
The Senate Finance Committee favors a proposal by Sens. John D. Rockefeller IV (D-W. Va.) and John H. Chafee (R-R.I.) to use the existing Medicaid program to cover children whose family incomes are less than 150% of the federal poverty line. Currently, children are eligible for Medicaid in California if family income is at or below 133% of the poverty line. We would support even more than the 150% cap for high-cost states like California.
On Wednesday, on the House side, the Commerce Committee is expected to push for a program of block grants to states with few stipulations on how to spend it.
In addition to having more bipartisan momentum behind it, the Senate’s Medicaid-based plan aims to reach the most needy children. It builds on a system that already has a specified benefit package and proven accountability. However, it is unlikely to reach all 10 million children lacking insurance. The Finance Committee estimates that it should cover about half that number.
In contrast, some popular House proposals have few strings attached, allowing the $16 billion to be channeled into state revenue streams. The hitch is that they could dry up in bureaucratic tributaries before they reach the kids.
Both the block grant and Medicaid expansion plans do not prevent employers from dropping coverage to children of employees, though the Chafee bill does say employers may not offer coverage for dependents selectively, for instance just to families of executives. About 90% of uninsured children in America are in working families. A 1997 federal report said the percentage of children covered by private health insurance fell from 73% in 1989 to 66% in 1995.
The Chafee bill is the better vehicle to get the $16 billion to children who need it. Congress should pass it now.