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.