The Sacrifice; Children’s Health Insurance Program [SCHIP] Costs

copyright © 2007 Betsy L. Angert.  BeThink.org

Each evening I go to sleep and hope that in the morning when I awake, the nightmare will be over.  I am unsure whether it has been days, weeks, months, or years since I felt as though there was reason to expect all would be well.  I contemplate the plight of many, and my heart bleeds.  I wonder; can we say we live for the Seventh Generation or must we accept that our progeny will not survive.  
When I consider the circumstances of children I weep.  Their health and welfare do not seem to fit into our adult plans or our budget.  I am concerned when I hear whispers and discussions; the State Children’s Health Insurance Program [SCHIP] costs too much.  I am more anxious since I learned the Bush Administration imposed stipulations; now the program will not cover many offspring in need.  Each of these distressing dilemmas, I think is symptomatic of an endemic problem.  We, the elders focus on financial matters more than physical realities.  

In America, adults believe a healthy economy equates to profits, not authentic assets.  Mature minds act as though people are worth less than a pocket full of coins.  Yet, individuals of age whose priorities are askew, determine what is best for the beloved young.   Frequently, those old enough to support themselves think of little but their individual survival.  Rarely, do working stiffs realize they are part of a community.  In America, until there is a time of crisis, it is every man or woman for his or herself.

It seems we, as a society, do not recognize that in each moment, we are part of a whole.  Each and every one of us belongs to a community.  Americans feel isolated, insulated from their neighbors.  As inhabitants of Earth, we are one.  What any of us does, will affect another.  Yet, we ignore this truth.  We disregard much.  We allow for what occurs, as long as we do not think it will harm us directly.  

This week, the Bush Administration took advantage of our apathy.  The Administration altered the regulations of the State Children’s Health insurance Program [SCHIP.]  Few Americans will blink an eye.  Most people are focused on providing for their families in the only way they know how.  They work.  Parents of the millions of children without insurance have learned to accommodate.  Some never knew they could apply for the Children’s Health Insurance Plan.
Residents of this country think themselves too busy, too stressed, too overwhelmed to worry about those outside their circle.  They go about their day doing what they know needs to be done, and do not realize what they overlook.  What occurs, even to the offspring they say they love is often too much to bear.  To ideate our intention, then ruminate on our reality is painful.

Many Eligible for Child Health Plan Have No Idea
By Kevin Sack
The New York Times
August 22, 2007

Greensboro, N.C. — During the four years that her children were uninsured, Cassie O. Hall used the emergency room as their pediatrician.  When Tayana had an asthma attack or Darren developed a stubborn rash, they would head to the hospital and settle in for a long wait.

The children never got physical exams or booster shots.  And as the unpaid hospital bills stacked up, the threshold for a visit grew higher.  “They would have to be half-dead before I would take them,” said Ms. Hall, a day care operator who could not afford private insurance.

It was only in May that Ms. Hall learned that her family qualified for the State Children’s Health Insurance Program, which provides subsidized insurance to children of the working poor.  That she had never heard of the joint state and federal program made her typical of countless parents of the estimated eight million uninsured children.

Despite a decade of marketing efforts by governments and private foundations, nearly 30 percent of children who are eligible for the health insurance program and are not covered by private plans have yet to enroll, according to a new government study.

The reasons for this are ample.  In America, families are in flux.  People move.  Households split.  One parent or another might think they are not responsible for the health care coverage of their child.  Those without often hide.  They are embarrassed by their circumstances.  

If a mother or father changes jobs, insurance may come or go.  Transitions may initially be thought temporary.  Perhaps, what occurs is merely characteristic of our culture.  People are busy.  They wait for a catastrophe before they act.

Possibly, the public will not express their concern because they do not recognize the depth of the dilemma.  Director of the Congressional Budget Office, Peter R. Orszag understands the reasons for this.  In a letter addressed to  United States Senator, Max Baucus, Chairman of the Committee on Finance he offers some insight into the information regarding uninsured children.

In response to your letter of July 10, the Congressional Budget Office (CBO) has examined available estimates of the number of children who lack health insurance, but are eligible for Medicaid or the State Children’s Health Insurance program (SCHIP). Some empirical studies have found that there are between 5 million and 6 million such children. In contrast to those studies, the Administration recently estimated that a much smaller number, 1.1 million children, lack health insurance but are eligible for Medicaid or SCHIP.

In an August 2005 report prepared for the  Robert Wood Johnson Foundation and completed by the State Health Access Data Assistance Center (SHADAC) and the Urban Institute using data from the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics and the U.S. Census Bureau’s Current Population Survey (CPS) researchers stated, in 2003, 8.4 million children are uninsured.  As noted, there is ample reason to believe the number is now much higher.  However, it is difficult to know what is valid.  Unfortunately, few care.  They have no time for such technicalities.

All around the nation, for adults, life goes on; day-to-day perceived “necessities” overwhelm them,.  Mature and “civilized” persons “must” consume petroleum products.  Grown-ups are required to ravage the terrain in an attempt to supply for our infinite “needs.”  We fight for freedom so that we might incinerate more oil.  We spoil the soil with waste from our factories.  Waterways are boulevards for gas-guzzling boats.  American citizens devour foods contaminated with chemicals.  

In the meantime, roads crack.  Rivers fill with filth.  The ozone layer deteriorates, as does the health of the planet.  Our children may feel the burden of our lifestyle more than we do.  Their little bodies are more susceptible to environmental influences.  Healthy habitats seem a thing of the past.

While we wallow in war and work for our individual riches, we ignore what matters most.  The quality of our shared existence; the importance of our common well-being, the children, their health, and ours.

Currently, young persons, those older and the elderly acquire chronic respiratory illnesses at a rate not thought possible.  The weight of the world settles in the bellies of a population grown fat.  We trust that someone, somewhere, will do what we dare not, consciously choose to care about more than the moment.  We seek a quick fix to all that ails us.  Perhaps, drugs will reduce the pain; however, who can afford a prescription.  Parents struggle to pay their own bills.  Children dependent on the care of a mother, father, guardian, or two parents often realize that unless they are severely ill, medical procedures must be postponed.

Many parents of uninsured children say they cannot afford unexpected medical bills and emergency room visits.  They report that they avoid medical costs whenever they can by treating illnesses at home with over-the-counter medications and home remedies.  Almost all say they postpone medical care for their children and put off buying prescription drugs when they can.  A parent of an uninsured child in Miami said, “We try not to get sick.  I try not to think about it too much.”

Americans avoid much in word and deed.  Citizens feel powerless.  They perceive the government is separate from them.  Senators, Congressmen, and women, even the President does not represent the common folk.  The conventional wisdom is “‘Politicians are crooks.”  The public, for the most part sees no reason to be politically active; apathy is rampant in the United States.

We do not understand that we “the people” are the authority.  Democracy defines ‘government’ as of, by, and for the people.  Our vote counts.  Yet, in a nation where the Administration implements regulations that conflict with the intent of the law, citizens forget, they have the clout.  In recent decades, Americans are reluctant to go to the polls.  

When the populace does vote, and embrace their authentic power, image, or electability, govern most decisions.  Candidates are sold to the people.  Pretty or popular persons are thought profound.  Yes, money moves much, perhaps all.  Certainly, the power of wealth is influencing the state Children’s Health Insurance Program.  Consider the Bush proposal.

[President Bush] He has proposed about $5 billion in new funding for children’s health insurance over five years, for a total of $30 billion — an amount that the Congressional Budget Office says would be too little to keep covering even just the number of children enrolled in the program now.

George W. Bush is not alone in his desire to under-fund the needs of the nation and its residents.  Most Americans want to keep their earned income in their personal pocket.  Residents in my region proclaim property taxes are too high; they must be cut.  The possibility alone has caused massive layoffs in this community.  City workers were awarded pink slips.  Immediately vandalism rose in public facilities.

Weeks ago, the nation heard of the collapsed bridge in Minneapolis and discovered there are thousands more troubled structures throughout the States.  As we, the people, spend billions, trillions on defense, our infrastructure crumbles beneath us.  Our progeny fall to pieces before our eyes, and we do little to help them.  Indeed, the rules are changed so that less of the littlest people will be cared for.

Rules May Limit Health Program Aiding Children
By Robert Pear
The New York Times
August 21, 2007

The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.

Administration officials outlined the new standards in a letter sent to state health officials on Friday evening, in the middle of a month-long Congressional recess.  In interviews, they said the changes were intended to return the Children’s Health Insurance Program to its original focus on low-income children and to make sure the program did not become a substitute for private health coverage.

After learning of the new policy, some state officials said yesterday that it could cripple their efforts to cover more children and would impose standards that could not be met.

“We are horrified at the new federal policy,” said Ann Clemency Kohler, deputy commissioner of human services in New Jersey. “It will cause havoc with our program and could jeopardize coverage for thousands of children.”

Stan Rosenstein, the Medicaid director in California, said the new policy was “highly restrictive, much more restrictive than what we want to do.”

The poverty level for a family of four is set by the federal government at $20,650 in annual income. Many states have received federal permission to cover children with family incomes exceeding twice the poverty level — $41,300 for a family of four.  In New York, which covers children up to 250 percent of the poverty level, the Legislature has passed a bill that would raise the limit to 400 percent– $82,600 for a family of four — but the change is subject to federal approval.

California wants to increase its income limit to 300 percent of the poverty level, from 250 percent. Pennsylvania recently raised its limit to 300 percent, from 200 percent. New Jersey has had a limit of 350 percent for more than five years.

As with issues like immigration, the White House is taking action on its own to advance policies that have not been embraced by Congress.

Immigration is not the only issue of import that calls the White House to action.  Frequently, the Bush Administration wields its power to protect entrepreneurs and discounts the value of employees.  The Executive Branch plans to do so again and again, much to the detriment of everyday folk.  Only weeks ago, workers died in mines notably too dangerous for man.  Wealthy businessmen or women, such as the colliery owner prefer to pay fines when “government” imposed industry standards [laws enacted for the good of the greater community] are not meet.

Mattingly: Robert Murray bought the Crandall Canyon mine only a year ago and, until the accident, it was one of his safest mines.  

But “Keeping Them Honest,” we checked government records, and found they list Murray as the head of 19 mining operations in five states.  Only seven are active underground mines, and four of them have injury rates above the national average.

 At the Galatia mine in southern Illinois, the rate of injuries has exceeded the national average every year since Murray bought the mine in 1998. The rate of injuries was almost cut in half from 2003 to 2006, but the mine has also racked up over 3,400 citations in the last 2 1/2 years, 968 so far this year, with nearly a quarter considered significant and substantial.

Ellen Smith, Mine Safety & Health News:  You wonder how that many violations can build up in that little amount of time.  Now, you have to remember he’s challenging a lot of the citations, but when you look, he’s also paid a lot in fines.

Mattingly: He paid almost $700,000 in fines from 2005 and 2006. So far, this year Galatia has been hit with 31 major citations, each exceeding $10,000. That’s more violations than any other mine in the country and second in total fines.  

(on camera) And Galatia wasn’t Murray’s first big problem. In 2003 managers at his mining company in Kentucky were found guilty of violating safety standards and attempting to cover it up. The company was ordered to pay a $306,000 fine.

(voice-over) Requests for comments from officials at Murray Energy were not answered. CNN asked Murray about safety records of his other underground mines at a news conference Monday.  Murray said he would only talk about Crandall Canyon.

Mine owner Robert Murray apparently recognizes that he, just as George W. Bush can control the conversation.  People will not protest loudly or for long.  It is [usually] safer to talk about the weather.  Let us discuss our current climate conditions.

Citizens in the Midwest experienced rains such as they have never seen.  Cities built on concrete cannot absorb the deluge.  The few trees that budgets maintain are toppled.  No matter.  

We have come to expect and accept global warming as a fact.  We do little or nothing to change the course nature now takes.  We discount the health of the planet, just as we disregard the well being of our babies or our own bodies.  Man does not seem to recognize a need for the oxygen foliage and flora provide, evident by deforestation and the lack of tree-lined streets.  Nor does he or she realize the health of our children correlates to the physical and moral condition of our broader communities.

Today, winds gust at speeds not recorded in year’s prior.  Hurricane Dean in Mexico, is now on people’s radar.  I am reminded of how, during the 2005 hurricane season, people in the plains expressed their resentment for the possibility that they may need to supplement the effort to rebuild with Federal funds.  Some thought those that live in areas such as Louisiana and Florida silly to request financial aid from those that reside in other areas of the country.  The cry was, “It is not my concern.”  Followed by “Why should I care?”

Perhaps, I can respond to that query in a meaningful manner.  When we do not care for others or their needs; ultimately, we will likely realize we did not care for ourselves.  We are indeed, all connected.

Children’s Healthcare Is a No-Brainer
By Amy Goodman
Truth Dig
July 24, 2007

Deamonte Driver had a toothache. He was 12 years old. He had no insurance, and his mother couldn’t afford the $80 to have the decayed tooth removed. He might have gotten it taken care of through Medicaid, but his mother couldn’t find a dentist who accepted the low reimbursements. Instead, Deamonte got some minimal attention from an emergency room, his condition worsened and he died.  Deamonte was one of 9 million children in the U.S. without health insurance.

Congress is considering bipartisan legislation that will cover poor children in the U.S.

The major obstacle? President Bush is vowing to veto the bill, even though Republican and Democratic senators reached bipartisan agreement on it. The bill adds $35 billion to the State Children’s Health Insurance Program over the next five years by increasing federal taxes on cigarettes.

The conservative Heritage Foundation is against the tobacco tax to fund SCHIP, saying that it “disproportionately burdens low-income smokers” as well as “young adults.” No mention is made of any adverse impact on Heritage-funder Altria Group, the cigarette giant formerly known as Philip Morris.

According to the American Association for Respiratory Care, with every 10 percent rise in the cigarette tax, youth smoking drops by 7 percent and overall smoking declines by 4 percent. Marian Wright Edelman, founder of the Children’s Defense Fund, says: “It is a public health good in and of itself and will save lives to increase the tobacco tax.  Cigarettes kill and cigarettes provoke lung cancer, and every child and every [other] human being we can, by increasing the cigarette tax, stop from smoking or slow down from smoking is going to have a public health benefit, save taxpayers money from the cost of the effects of smoking and tobacco.”

Two programs serve as the health safety net for poor and working-class children: Medicaid and SCHIP (pronounced “s-chip”).  SCHIP is a federal grant program that allows states to provide health coverage to children who belong to working families earning too much to be eligible for Medicaid but not enough to afford private health insurance when their employers do not provide it.  It’s the SCHIP funding that is now being debated in Congress.

The Children’s Defense Fund has published scores of stories similar to Deamonte’s. Children like Devante Johnson of Houston. At 13, Devante was fighting advanced kidney cancer.  His mother tried to renew his Medicaid coverage, but bureaucratic red tape tied up the process.  By the time Devante got access to the care he needed, his fate was sealed. He died at the age of 14, in Bush’s home state, only miles from the M.D. Anderson Cancer Center, one of the world’s leading cancer treatment and research facilities.

Our children depend on us and we ignore their pleas and their plight.  Possibly, we are as we remember. Our parents counted the available cash, they pinched pennies, or saved for the rainy day.  Perhaps, we are far worse.  We are not the providers our mothers and fathers were, and there in lies the problem.  

The percentage of children under 18 who are uninsured rose from 10.8 percent in 2004 to 11.2 percent in 2005, while the number of uninsured children climbed from 7.9 million in 2004 to 8.3 million in 2005, an increase of 360,000.

 We cannot be certain these numbers are accurate.  As stated earlier, the current Administration tweaked the accounts.  Thus, what we believe to be true may be as dependent as our children are.  Nonetheless, we must understand that uninsured children will suffer even if Congress can override an expected Presidential veto.  

As of late August 2007, the State Children’s Health Insurance Program Bill [SCHIP] is not the healthy plan it was intended to be.  For months, the White House wrangled with members of the House and Senate; they argued over the finer points of the State Children’s Health Insurance Program, The cost and the conditions necessary for application were in question.  Lawmakers see a need to expand the program.  The Bush Administration favors cuts.  While Congress was in recess, during the quiet days of summer, the Executive Branch stepped in and stripped the law.  The effectiveness of a popular children’s health insurance program is now lost.  In its current form, the Bill is but a skeleton, bare to the bone.  New rules mandate States . . .

Establish that the child has been without health insurance for at least one year.

Assure the federal government that at least 95 percent of children currently eligible for S-CHIP or Medicaid are enrolled in one of those programs.

Make sure that an S-CHIP family’s contribution to its health care costs (premiums, co-pays and deductibles) is only slightly less than the family would pay for a comparable private insurance plan.

One can only sigh as Ann Kohler, New Jersey Deputy Commissioner of Human Services does.  She shrugs and states this part of the law is unfair.  “I cannot imagine any state being able to comply with that.”

Judith Solomon, of the Center on Budget and Policy Priorities, used to run the outreach program for Connecticut’s S-CHIP program. She says you couldn’t get that enrollment rate up to 95 percent even if you knocked on every door in the state looking for eligible kids. There are language barriers — people who just don’t want public assistance — and it’s a population that’s always in flux.

“Children are born, children age out, they reach age 19 and are no longer eligible,” Solomon says. “Family income goes up, family income goes down; it’s a very dynamic situation.”

Once again, we are reminded, the elders focus on financial matters more than physical realities.  In this nation, people are not the priority.  Political gestures, those that favor friends, take precedence.  

For the President, insurance companies are more likely to fill his pockets than the poor and impoverished will.  For we, the people, particularly those whose purses are empty, might we stop and consider what brings us greater fulfillment.  Is it our children, our community, or our self-imposed ignorance.  Might we embrace empathy, love our neighbors more than the almighty buck, endow our children with quality health care services, and enjoy what truly matters, people and the profound affect we have on the life of our community.

Sources for State Children’s Health Insurance Program . . .