File this one under "Law of Unintended Consequences" and hope to God someone brings this to the attention of the relevant parties:
Where are the chips falling, so to speak, when it comes to the popular State Children’s Health Insurance Program (SCHIP)? The press ought to be finding out, and fast. Last week, the Children’s Defense Fund sent me an invitation for an informational call discussing SCHIP’s future: “If the Senate doesn’t take a stand for children in the next days or weeks, our worst fears could clearly come to pass.” The dire-sounding invite piqued my interest, especially since I had read in the House bill that SCHIP would be repealed. What was going on?
It turns out that the House indeed wants to repeal the program and require kids to get coverage via the insurance exchange, the government’s soon-to-be gigantic brokerage service. Their parents, of course, would be getting subsidies to help buy coverage, courtesy of the U.S. taxpayer. Rep. John Dingell, a Democrat no less, touted the advantages of dumping SCHIP. One advantage: the program wouldn’t be subject to the periodic and occasionally problematic Congressional reauthorizations that threaten its existence. Dingell said kids could have the same insurance as their parents—an incentive to force parents to cover their kids. (Sometimes parents, daunted by bureaucratic red tape, don’t enroll their children even if they are eligible.)
Another reason for killing SCHIP, some believe, is to force kids into the new exchange’s risk pool. Kids are usually healthy; bringing them into the pool may help spread the risk and keep premiums somewhat lower for the sick people whom insurers would have to cover.
But in return, kids would be hurt, says Alison Buist, director of child health at the Children’s Defense Fund. She told me that if the House provision were to take effect, kids might lose some valuable and comprehensive benefits now available to kids on Medicaid and SCHIP. If parents, strapped for cash, had to shop in the exchange, they might choose low-cost insurance with skimpy benefits and pay more out-of-pocket than SCHIP currently requires them to pay. SCHIP rules limit a family’s out-of-pocket costs to five percent of their income. States don’t even impose the five percent, Buist said, because they have found parents with low incomes couldn’t pay that much. So it seems that there’s a cost shift here—making poor families pay more so that sick (and most likely older) people buying in the exchange would pay less.
The more I see of this Frankenstein plan, the more I see we need single-payer universal coverage. Period.