Joseph Antos, a health policy analyst with the conservative-leaning American Enterprise Institute in Washington, cautioned against putting too much stock in the statistics, but doesnt discount them or the direction theyre heading out of hand. Politically, Antos said, these will be used as a blunt instrument against Republicans. That would be normal. But, if a Democrat was in office today and these numbers had come out, they would have showed the same thing.
And as predicted, it took only minutes after their release for that to happen. Washington has had a long history of combing through government reports to cherry-pick data that support a particular platform or position, policy analysts pointed out. The latest census report has even more traction this year since it drops at a time when federal lawmakers are quarreling over howand by how much they should expand SCHIP.
Sen. Edward Kennedy (D-Mass.), chairman of the Health, Education, Labor and Pensions Committee, for instance, used the report to hammer away at the Bush administration, which has said it would veto both the Senates and Houses SCHIP bills unless theyre dramatically scaled back. Kennedy said the presidents veto threat is baffling, and that he hopes the census report will cause him to reconsider that threat.
Earlier this month, the Bush administration issued new federal SCHIP criteria for covering higher-income children, a move that was opposed by healthcare providers, state officials and others. On Aug. 17, the CMS said that states would first have to enroll 95% of those eligible for SCHIP in households making under 200% of the federal poverty level, or about $41,300 for a family of four, before they can extend coverage to children in households making about 250%. The problem is that no state is currently at that level, so the new policy is going to restrict everyone, said Stuart Cohen, a practicing pediatrician in San Diego and a local spokesman for the American Academy of Pediatrics.
Some hope the census numbers will spur action on renewal of SCHIP. Senate Finance Chairman Max Baucus (D-Mont.), who spearheaded passage of the Senate SCHIP bill, said that the census report should be used to jump-start the stalled debate on Capitol Hill, and he called on colleagues to act quickly to pass a robust renewal of the program.
Still, its uncertain just how the report will play in Congress, policy analysts said. The Census Bureau is telling us that the problem is getting much worse, said Drew Altman, president and CEO of the Kaiser Family Foundation. But the big branches of governmentthe White House and Congressare locked in a fundamental disagreement embodied in huge ideological and policy differences.
To be sure, the White House has hinted in a statement that it wont back down from its veto threat. What American workers do not need right now are tax increases to fuel excess spending by the Congress, Bush said. Both versions of the SCHIP reauthorization bill rely on a hike to the federal tobacco tax, but the White House has charged that the House version would lead to broader increases in taxes in the long run.
The debate over the meaning of the census numbers is certain to move off Capitol Hill and into the presidential primaries, where candidates from both parties have already begun the healthcare discussion.
Democratic presidential candidate and New York Sen. Hillary Rodham Clinton used the report to show her own healthcare bona fides and to vilify the Bush administration. When I began the fight for universal coverage almost 15 years ago, there were 37 million people uninsured, she said in a written statement. It was an outrage then and with 10 million more people uninsured today, it is an even deeper outrage today.
Earlier in the week, during a question-and-answer panel in Washington, GOP candidate and former Massachusetts Gov. Mitt Romney earned applause when he told an audience that he favors health coverage for all Americans.
The topic is likely to remain front and center. The real debate is a governing debate, Tallon said. Its a debate that will occur in (2009 after the election) and beyond. The two parties are presenting to the American people pretty strong differences and points of views on this subject.
The AFL-CIO, in a bid to influence candidates, unveiled its campaign to cover the uninsured last week (See story, p. 7).
Meanwhile, individual states have begun to take the healthcare reform reins from the federal government. In New York, Gov. Eliot Spitzer has pushed a plan to insure about 400,000 children who currently have no health coverage and in April signed into law the Child Health Plus expansion. The program would expand the SCHIP to families making up to 400% of the federal poverty level, or about $82,600 for a family of four.
But that state plan has run headlong into the new rules crafted by the Bush administration, intent on handcuffing states from expanding the program. Last week, Spitzer said he would consider legal action against the CMS if it does not reverse the rules.
Fundamentally, were saying give us the tools, give us the help out of Washington, and we really do have the will and ability to undertake this responsibility, Tallon said.