Express Lane SCHIP
There’s a website my son showed me called howstuffworks.com. I don’t think what I want to write about today can be found there. However, my thoughts fit into that category. I want to explain how just one provision of the SCHIP bill the President vetoed would have worked and why we insist it is changed.
First, let me make a couple of points. Whoever said “the devil is in the detail,” must have been talking about legislation. This bill was written in consultation with people who knew exactly what their goal was: universal, government-run, taxpayer-financed health care for citizens and non citizens alike in the United States. Second, this bill clearly moved multiple steps toward that end.
The President and I believe every American needs health insurance, but our vision of how to accomplish it is fundamentally different than the Democrats’. We believe government should offer insurance to citizens in hardship, like poor children (Medicaid and SCHIP), and low income adults (Medicaid), like the disabled and elderly (Medicare). However, we believe government can organize the private marketplace so everybody else can choose their own plan, and choose their own doctor and hospital. We believe consumers make better decisions about their health than the government does. We think competition drives quality up and cost down.
Last week, we made clear that we want this program reauthorized and we are willing to assure there is enough money in the budget to cover poor children. What we aren’t willing to do is fund the program with $15 to $18 billion dollars more than is needed. And we don’t believe it is necessary to raise taxes to do it.
Now, back to the devil in the very clever and deliberately hidden details of the vetoed bill. The bill has a basic strategy: Flood the program with money and then build into the language of the bill methods of blowing the doors open for eligibility. In short, use the language of poor children to fill the money bucket up. Then, when taxpayers have committed money, we can expand the population of those who get the benefit to include adults, aliens, and higher income people who have private insurance now.
There are several glaring examples of how this bill was designed to do exactly that. One method used is hidden under the phrase, “express lane” enrollment. This allows states to delegate deciding if people are eligible for SCHIP to others, like schools. It then provides that if the school decides they are eligible for subsidized school lunch they can get Medicaid and SCHIP.
Here’s the really clever part of this camouflage. Schools don’t have any way to enforce eligibility by income or citizenship for subsidized school lunch, let alone SCHIP. If there is any question, they put children into the program. Talk to anybody knowledgeable about school lunch programs and they will tell you, significant numbers of children are deemed eligible for these programs that aren’t.
The school doesn’t even have to have the signature of the family, nor does the family really have to verify income or citizenship status or other important information such as whether the family already has health insurance.
What’s the penalty if a state lets lots of people who aren’t eligible into the program? Virtually none; again, let me explain how the bill would work.
Assume the federal government wanted to check up on a state to assure they are keeping the rules. It is not possible to check every file, so the logical thing would be to pull a scientifically drawn sample of all their enrollees, survey those cases for compliance, drawing conclusions based on the survey for the entire program. If say, a thousand cases are checked, statistically you can predict the compliance of the entire group.
Let’s say, the sample found 200 of the 1000 were falsely allowed in the program, or 20% of the entire program. The law would simply allow the federal government to ask for its money back on the 200 specific cases. But the bill actually prohibits the federal government to make the states accountable for the tens of thousands of cases the sample represents.
In other words, the bill not only makes it easy for ineligible people to get in the program; it also takes away any meaningful penalties for states that put them there. In fact, it creates massive financial incentives for states to do so.
We are all for signing up kids and even signing up kids fast. States can use presumptive eligibility but still maintain the integrity of the program by running a full eligibility determination. States can send eligibility workers with laptops into the schools to take applications, but we should not ask taxpayers to foot the bill for people who are not eligible.
There are many other reasons the President vetoed this bill. I’ll write more later.
Posted on October 31, 2007 in Medicare
, SCHIP
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Mr. Secretary
Howstuffworks is a great website. Most of us get howstuffworks when we reach our later years. Some of us have even tried to rise above howstuffworks. The do unto others is more important than howstuffworks in my book and omission is also self correcting. It tests the mettle of anyone who has reached this stage of their journey. I hope that your son reads a great deal about howstuffworks but also becomes strong when it is time to think outside the box.
With Sincerity and Respect.
Posted by: standingfirm | October 31, 2007 at 06:34 PMMr. Secretary,
I am glad the President vetoed that bill. Kudos to him.
SF
Posted by: standingfirm | October 31, 2007 at 06:35 PMMr. Secretary,
Posted by: | November 01, 2007 at 04:52 PMI am too glad that the president vetoed this bill. It seems as though he has a greater plan and hopefully will take action with that plan and put it into place which I believe will help Americans much more than they we may realize.
Sincerely,
HC
When consumers make decisions about their health they demand antibiotics for viral diseases. They demand CT scans and MRI's when it is unjustifed and has a poor benefit/risk ratio.
Consumers always make the final decision about their health care.
Subject matter experts (The best most knowledgable doctors who do not have direct financial interests in patients seeking unwarrented care) should be allowed to craft the framework for health care decisions.
Posted by: Robert Walker | November 02, 2007 at 08:54 AMMr. Secretary,
Already it is becoming apparent the the combination of MRSA and seasonal flu is going to create problems.
Is it time to start vaccinating all of the children and young adults with pneumovax 23?
Is the vaccine plentiful? What would be the contraindications to this?
Posted by: standingfirm | November 02, 2007 at 08:57 AMHow stuff works has this to say about malaria:
Posted by: Robert Walker | November 02, 2007 at 09:02 AMWhile chicken pox is still a relatively common occurrence, diseases like malaria and diphtheria seem to have been wiped out ages ago.
http://health.howstuffworks.com/12-deadly-diseases-cured-in-the-20th-century.htm
This contrasts with the Bill and Melissa Gates Foundations beliefs.
The insurance "industry," needs a complete overhaul. As it stands now, working-class Americans who work for small businesses are generally either UNinsured or UNDERinsured. And as you should know, the majority of businesses in America are classified as "small."
As it stands now, only the very wealthy, or the professionally poor (Welfare abusers) have decent health care coverage in America. The working and Middle-classes are squeezed and must go with less or completely without.
The insurance companies have all of the power to dictate how much their "products" cost, and to whom they will cover, and the worker is left without because the small business he works for doesn't have the capital to access group.
Yet we have billions to pour into Iraq. Yet we have billions to give to Israel, Saudi Arabia and Egypt. Yet we continue to allow millions of illegal aliens to invade our country.
Sad.
Posted by: Ronald L | November 02, 2007 at 01:23 PMMr. S - Lets talk about nursing care in a Pandemic.
The nurses will be our front line defense... take a look at what the nurses actually have to say about it here
http://allnurses.com/forums/f8/will-you-work-during-pandemic-258506.html
Looks like without proper PPE your front line soldiers will be missing in action.
I think it's time to address their concerns.
Posted by: Goju | November 02, 2007 at 03:58 PMMr. Secretary--
While I generally agree that an insurance system based on private insurance and market forces is preferable than a single payer government run system, children as with the elderly, seem to be a reasonable exception. Never do I feel less of a physician than when I see a child in my office and hand them the bill afterward.
Posted by: CountryDoctor | November 03, 2007 at 11:50 AMSenator Lugar (R-IN) knows more about school lunch and food stamps than just about anybody and he is the author of the Express Lane legislation. He supports overriding the president's veto and said the following about Express Lane:
Lugar Addresses Express Lane Eligibility in SCHIP
U.S. Sen. Dick Lugar sent the following letter to his Senate Republican colleagues today to address misconceptions regarding the Express Lane eligibility option in the SCHIP bill:
“I am writing to correct some misconceptions regarding the Express Lane eligibility option in the SCHIP bill.
“More than 70% of low-income, uninsured children are in families that are already enrolled in the Food Stamp program, the Women with Infants and Children (WIC) program, or the National School Lunch Program (NSLP). The idea of Express Lane is to give states the flexibility to find a child income-eligible for Medicaid or SCHIP based on the fact that they have already been found eligible for nutrition assistance or other comparable programs that operate under similar financial guidelines. Express Lane was included in then-Majority Leader Frist’s child health bill during the previous Congress, which the Administration supported.
“Express Lane is targeted at the very poorest uninsured and eligible children who have been the hardest to reach through other methods. For example, in my own state of Indiana there are approximately 70,000 children currently enrolled in Indiana's SCHIP program, yet approximately 39,000 children are eligible but not enrolled.
“The Administration has voiced concern that Express Lane eligibility would allow illegal immigrants into the program. Express Lane eligibility does not change eligibility standards for Medicaid or SCHIP and thus undocumented immigrants would remain barred from coverage. Express Lane simply allows states to use relevant eligibility data from other programs. If states were using data from a program that did not have a citizenship determination, the state would need to find independent documentation of citizenship or satisfactory immigration status, using normal Medicaid/SCHIP procedures. The Express Lane language is explicit in requiring citizenship documentation.
“Furthermore, it is important to note that the compromise agreement for the first time requires explicit determination of citizenship status for SCHIP rather than self-declaration. Therefore, the citizenship provisions of the bill are now more stringent than current law.
“There is also a concern that the Express Lane language would allow families of higher income levels into the SCHIP program. It is important to note that the income thresholds of almost all other need-based programs are substantially lower than SCHIP eligibility levels, so it is highly unlikely that any otherwise ineligible children would receive health coverage. For example, programs like WIC and School Lunch go up to 185% FPL, calculated based on gross income. In most states, SCHIP extends to 200% FPL, subtracting from gross income such things as child support payments, certain work expenses, etc.
“However, the Administration has implied that because other programs -- such as School Lunch -- have differing standards of income eligibility, they are vulnerable to fraud and abuse, and therefore SCHIP would be in jeopardy of signing up ineligible children. Individuals participating in the School Lunch program are subject to income verification and/or audits. Those who intentionally attempt to defraud the program become ineligible and punitive actions could be considered. If the Administration is suggesting that there are problems administering their own programs, we would be happy to work with them on this.
“In the meantime, it is important to note that the Express Lane provision requires CMS and states to audit children who receive Express Lane eligibility and to report the results. If 3% or more of Express Lane children are ineligible for health coverage, corrective action plans are required, and federal sanctions apply to funding for children in the sample.
“Also worth noting, when Express Lane eligibility has been used for the School Lunch program and for WIC, program integrity improved and administrative costs fell, according to research by USDA and the GAO.
“In my view, the Express Lane provision in the SCHIP bill meets the important Republican priorities of a) targeting SCHIP coverage to eligible but un-enrolled children under 200% of poverty, and b) increasing efficiency and reducing red tape. “
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Posted by: Standing With Children | November 05, 2007 at 11:55 AMI happened upon Mr. Leavitt's page while doing a research project. I appreciate his explanation regarding the veto. I had previously listened to all the rhetoric and had not taken the time to look deeper. I feel better informed and am grateful for the veto. This is a great site. I will visit again.
Posted by: Kathy Kinghorn | November 12, 2007 at 12:22 PMMr. Secretary,
Posted by: cesaretin varmi aska dizisi | June 14, 2008 at 12:50 PMI am too glad that the president vetoed this bill. It seems as though he has a greater plan and hopefully will take action with that plan and put it into place which I believe will help Americans much more than they we may realize.
Sincerely,
HC