The Day: Congressmen Blast Feds on Child Insurance Policy Change

Hartford: Democratic U.S. Reps. Joseph Courtney and John Larson sharply denounced a recent change in federal policy Tuesday that they said could bump thousands of children out of Connecticut's health-care programs for the working poor.

Courtney and Larson joined officials from the Connecticut Children's Medical Center in Hartford to condemn an Aug. 17 directive that substantially reins in the efforts by individual states to expand coverage of low-income children through the State Children's Health Insurance Program.

That federal program is the funding source for Connecticut's HUSKY B health program, which has been expanded in recent years to provide low-cost health insurance for children whose families earn up to 300 percent of the federal poverty level.

Courtney, who represents the 2nd District in eastern Connecticut, and Larson, of the 1st District encompassing greater Hartford, joined a bipartisan majority in Congress that voted to substantially increase funding for the SCHIP just before departing for the annual August recess.

But the Aug. 17 letter to state officials from Dennis G. Smith, the director of the Centers for Medicare and Medicaid Services, orders new restrictions on the income thresholds of SCHIP-funded programs, and would effectively limit states to covering children up to 250 percent of the federal poverty level — or $42,925 per year for a family of three.

The change could bump out of the HUSKY B program as many as 3,500 children whose families earn just enough to make them ineligible for coverage, Courtney said, citing figures from the state Department of Social Services. Other advocacy groups peg the figure as high as 4,300.

Smith's letter orders any state that seeks to expand eligibility for SCHIP-funded children's health plans to those earning more than that 250 percent threshold to adopt “crowd-out strategies,” designed to prevent those who might otherwise pay for coverage from private insurers from enrolling in government plans. They include a mandatory one-year waiting period during which individuals must be uninsured before they receive coverage.

And the letter also includes a requirement that Courtney and Larson — like both Republican and Democratic officials around the country — have said is so stringent it would be impossible for any state to meet: Before expanding above 250 percent of the federal poverty level, a state would have to certify that at least 95 percent of kids already eligible for health-care coverage under SCHIP are receiving that coverage.

Speaking to a mixed crowd of reporters, doctors, hospital staff and patients in the cafeteria of the medial center, Larson dismissed the Medicaid directive as political “posturing,” noting that it had not been sent until after Bush had threatened to veto a Senate version of the SCHIP funding bill.

And Courtney was just as critical, saying that the administration was sending mixed messages to states like Connecticut, which has previously received Washington's blessing when it augmented the Medicaid programs with state money in an effort to offer insurance to a broader swath of uninsured children.

“It's very schizo,” Courtney said, “because they are the ones who have granted waivers for New Jersey and New York and Connecticut. I think that's really what caught people by surprise, that the same agency that's been giving states the green light suddenly came out with this.”

The opposition, Courtney said, is “ideological.”

“There is a school of thought in these pretty conservative think tanks that SCHIP is crowding out private health insurance, that it's too easy to enroll, and that this approach is damaging” to the industry, he said. “... There really has not been any study that has demonstrated that the drop in private health coverage is a result of the availability of HUSKY. It's because of the costs.”

A spokeswoman for the Centers for Medicare and Medicaid Services declined to respond to the congressmen, saying she expected that the agency would negotiate with congressional leaders when attempts to reconcile House and Senate funding bills for SCHIP begin next month.
There is resistance at the state level, too, including from Republicans like Gov. M. Jodi Rell, who have invested in expansions of state health-care programs.

“The governor has said that wherever the final resolution is on the SCHIP issue, it's important that the federal government take no action that would represent a step backward for states like Connecticut that are trying to include as many people as possible in HUSKY,” said Rell's spokesman, Chris Cooper.

Medical experts are just as determined not to roll back previous years' expansions in insurance for low-income children, saying it is both a moral imperative and a better investment than paying for exacerbated health problems down the road.

“I think it's obvious ... that all children deserve the health care they need to learn and to grow,” said Martin J. Gavin, the president and CEO of the medical center. “And state-sponsored programs are absolutely critical to making that happen.”

Gavin said 45 percent of children treated at the hospital are covered by HUSKY.

The same day that the congressmen voiced their concerns brought new figures on the lack of insurance nationwide, where 47 million Americans lack health coverage, according to the U.S. Census Bureau, and in Connecticut, where there was apparently a modest reduction in the uninsured between 2005 and 2006.

The state's uninsured ranks decreased slightly, according to the census figures, from about 381,000 in 2005 to about 325,000 in 2006. The numbers are approximate since they are dependent on a small sample size.

The same census figures also appear to show that more residents, including children, relied on some form of Medicaid assistance — including SCHIP coverage like HUSKY — for health coverage in 2006. While 18.6 percent of children in Connecticut received some form of Medicaid coverage in 2005, the figure rose to 23.7, or about 195,000 children, one year later.

To advocates of HUSKY, that's a reason to keep expanding the program, not to circumscribe it as they say the Bush administration now threatens to do.

“If the feds are going to move back, then obviously we're going to lose on those gains, and more kids are going to be uninsured,” said Ellen Andrews, executive director of the Connecticut Health Policy Project.

House and Senate members will meet in conference next month on the proposals to reauthorize the 10-year-old SCHIP program. The House plan, which both Courtney and Larson have supported, would provide $50 billion in funding for the program, enough to raise income thresholds to 400 percent of federal poverty level.

By Ted Mann, The Day, 8/29/2007