Sens. Robert Menendez (D-N.J.) and Gordon Smith (R-Ore.) on Monday sent a letter signed by 44 senators to President Bush requesting that he rescind new rules issued last month that limit State Children's Health Insurance Program enrollment to the lowest-income children, CongressDaily reports (Johnson , CongressDaily, 9/11).
Under the standards, states must demonstrate that they have enrolled at least 95% of children in the state in families with incomes below 200% of the federal poverty level who are eligible for Medicaid or SCHIP before expanding eligibility to children in families with incomes greater than 250% of the poverty level. States seeking to expand SCHIP eligibility also must establish a minimum of a one-year period of uninsurance for individuals in families with incomes greater than 250% of the poverty level to prevent them from switching from a private insurance plan to a public program (California Healthline, 9/5).
In the letter, the senators say that they "oppose these new requirements as they will result in the loss of coverage for tens of thousands of children and could block efforts under way by other states working to insure more kids" (Lee, Washington Post, 9/11).
The senators continue, "We agree that all states should be making an effort to identify and enroll low-income children in Medicaid and SCHIP," but the new guidelines require states "to meet unattainable enrollment levels and will only result in loss of coverage." The letter also states that the guidelines should have been approached "as a formal rule under normal procedure with a notification and comment period."
Signatories to the letter included five Republicans in addition to Smith -- Sens. Olympia Snowe (Maine), Susan Collins (Maine), Arlen Specter (Pa.), Norm Coleman (Minn.) and Kit Bond (Mo.). The letter also was signed by Democratic presidential candidates Sens. Hillary Rodham Clinton (D-N.Y.) and Barack Obama (D-Ill.) (Johnson , CongressDaily, 9/11).
Medical Group Lobbying
Meanwhile, state medical societies and dozens of physician groups on Monday sent a letter to Senate Majority Leader Harry Reid (D-Nev.) urging him to include in final SCHIP legislation a reversal of a scheduled physician payment cut under Medicare, CQ HealthBeat reports (CQ HealthBeat, 9/10).
The House bill (HR 3162) contains the payment cut reversal, while the Senate bill (S 1893) does not address physician reimbursements (Johnson , CongressDaily, 9/11).
According to the letter, if Medicare payments to physicians are cut by 10% as scheduled in 2008, "60% of physicians will have to limit their acceptance of new Medicare patients, and two-thirds of physicians plan to deter the purchase of information technology." The letter was delivered "amid rumors" that House Democrats were considering removing Medicare provisions from the SCHIP bill, according to CQ HealthBeat.
The American Medical Association and AARP on Sept. 7 also sent a letter to congressional leaders urging House and Senate lawmakers to include "critical Medicare improvements for physicians and beneficiaries from the House package" as part of the final SCHIP bill (CQ HealthBeat, 9/10).
The American Cancer Society has supported the House package because of a provision that eliminates copayments for preventive screenings. However, America's Health Insurance Plans has lobbied for the Senate version of SCHIP legislation, saying that seniors would be "pushed out" of Medicare Advantage plans if the House SCHIP legislation -- which contains cuts to those plans -- is enacted (Johnson , CongressDaily, 9/11).
In addition, the Alliance for Quality Nursing Home Care and the American Health Care Association, two nursing home groups, have launched advertising campaigns against the House bill, which includes a $2.7 billion Medicare funding cut to skilled nursing facilities (Frates, The Politico, 9/10).
Comparative Effectiveness Research
A provision in the House SCHIP bill that would create a Center for Comparative Effectiveness Research and a Health Care Comparative Effectiveness Research Trust Fund for the first decade would cost the government more money than it would save, according to a Congressional Budget Office scoring document released last week, CQ HealthBeat reports.
CBO estimates that the provision would cost the federal government $600 million over five years and $2.4 billion over 10 years. Direct federal spending would increase by $500 million over five years and by $1.1 billion over ten years, according to the scoring.
The research produced by the center would reduce federal health spending by about $100 million over five years and $1.3 billion over ten years.
The center would reduce overall health care spending if private sector spending is included in the analysis, CBO Director Peter Orszag wrote in a Sept. 5 letter to House Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.).
Total spending by private and public insurers would be reduced by about $6 billion over 10 years, according to CBO.
Despite the "time it would take to generate a payoff, [Orszag] has repeatedly suggested that such research is one of the keys to assuring the long-term financial viability of the Medicare and Medicaid programs without undermining patient care," according to CQ HealthBeat (Reichard, CQ HealthBeat, 9/10). The CBO letter is available online (.pdf).
Focus on Middle-Class Voters
The Christian Science Monitor on Tuesday examined how Democrats "are stepping up a quieter, sustained campaign" to "win over more middle-class voters" by emphasizing certain domestic issues, including the passage of SCHIP legislation. SCHIP has "a big payoff for middle-class voters," according to the Monitor.
Norman Ornstein, a senior fellow at the American Enterprise Institute, said, "Democrats have a good approach: The issues are terrific ones, because they resonate with people hungry for something that helps them in their daily lives."
Although Democrats "will be hard-pressed to get much" of their agenda "to the president's desk," campaign analysts "say that the move to make small gains targeting the middle class is a shift for Democrats that could pay off" during the elections next fall, the Monitor reports (Russell Chaddock, Christian Science Monitor, 9/11).
Several newspapers recently published editorials and an opinion piece on SCHIP. Summaries appear below.
- Jim Wooten, Atlanta Journal-Constitution: "The president has the veto pen, and he should use it on either version of SCHIP," and he also should "take up the crusade on earmarks," including those present in the House SCHIP bill, Wooten, associate editor of the Journal-Constitution editorial pages, writes. Wooten concludes, "In the meantime, however, his administration is demonstrating life and a willingness to use the bureaucracy to fight back on the unnecessary expansion of government" (Wooten, Atlanta Journal-Constitution, 9/11).
- Dallas Morning News: "Those advocating a dramatic spending increase for" SCHIP "clearly have the best sound bites," but "when you examine Congress' proposed expansion of the federal/state program, the deal deserves the veto" that Bush has threatened, according to a Morning News editorial. The editorial continues that "the health care debate America should be having is more fundamental than this sort of piecemeal change," concluding, "There may be a way to expand the program within the context of a larger health strategy, but simply spending more federal dollars to push it into the middle class on its own is not the answer" (Dallas Morning News, 9/9).
- Long Island Newsday: Bush "has cast the fight over the future" of SCHIP "as a war between champions of socialized medicine and guardians of the private medical system," but "that's an ideological sideshow," according to a Newsday editorial. Although Bush's "rebuff" of New York's request to insure children in families with annual incomes up to 400% of the federal poverty level under SCHIP "is no surprise," it is "still wrongheaded," according to the editorial. None of the reasons given by the administration for refusing New York "justifies leaving uninsured children out in the cold," the editorial concludes (Long Island Newsday, 9/11).