Expanding access to healthcare services for children is moving into the center ring in Washington.
President Clinton's fiscal 1998 budget plan aims to expand healthcare coverage for uninsured children through a $2.8 billion package of Medicaid expansions, private-insurance subsidies for laid-off workers and new state grants.
Joining a number of legislative proposals on Capitol Hill, Clinton's package is estimated to extend coverage to up to half the country's 10 million uninsured children.
Advocates for expanding coverage say the White House and Congress are responding in modest ways to a public mood in favor of protecting working families from the costs of care for children.
"I think it's become a popular thing to do because there's a desire to help working families," said Ron Pollack, executive director of the healthcare consumer group Families USA. "This is viewed as part of an effort to help lower-wage working families."
In fact, Clinton's budget reframes one of his past healthcare reform initiatives as a children's health issue. That initiative, estimated to cost $1.7 billion in 1998 and $9.8 billion from fiscal 1998 through 2002, aims to extend health insurance coverage for six months to temporarily unemployed workers through Medicaid, COBRA or an independent program. COBRA is the Consolidated Omnibus Budget Reconciliation Act, a federal law that allows workers to continue their employer-sponsored coverage at their own expense after they lose their jobs. The initiative would cover 700,000 children in 3.2 million families, the White House said.
Other budget provisions include:
$750 million in fiscal 1998 and $3.8 billion from fiscal 1998 through 2002 in grants to help states build on programs to expand healthcare coverage to an estimated 1 million children.
Ensuring one year of Medicaid coverage for children, regardless of parents' eligibility for other welfare benefits. The White House said that would help 1 million children retain coverage.
Asking governors to increase Medicaid enrollment among the 3 million children who are eligible but not enrolled. Clinton administration officials said that initiative may add 1.6 million children to Medicaid rolls.
Although congressional Republicans have indicated they want to expand healthcare coverage for children, some warned it could be a foot in the door for a comprehensive healthcare reform measure like Clinton introduced in 1993.
Sen. Paul Coverdell (R-Ga.) said because healthcare for children became a rallying cry in the late days of the 1994 healthcare reform debate, children's healthcare could become a marketing tool for more comprehensive reform.
"They've been seeking to find some way to market something that the country really doesn't want," Coverdell said. "Given what happened at the end, it does makes you suspicious that we may be dealing with some marketing here."
Coverdell and Sen. Phil Gramm (R-Texas), chairman of a Senate Republican healthcare task force, have announced their intention to push legislation that would make the cost of health insurance deductible from taxable income for families with children under 19 and income less than three times the federal poverty level.
The idea of altering the tax code to expand coverage has crossed party lines. Senate Minority Leader Thomas Daschle (D-S.D.) has proposed legislation under which families that buy health insurance policies for children under 19 would receive a tax credit for up to 90% of the cost of the premiums. The value of the credit would shrink with higher incomes and be phased out for families with incomes of more than $75,000.