We Can't Ignore Children's Health-Care Needs

Opinion Piece by Congressman Joe Courtney

We have a moral obligation to provide Eastern Connecticut's children, and those throughout the United States, with access to heath care. This cause should be one of our nation's top priorities, but sadly the White House does not seem to share the same values.

Congress recently sent President Bush a comprehensive five-year reauthorization of the State Children's Health Insurance Program, more commonly known as HUSKY B in Connecticut. Instead of embracing the will of Congress and the American people, the president inexplicably vetoed the bill. He chose to deny millions of children access to doctors, rather than supporting their welfare and well-being.

President Bush is wrong. The fight he is waging on America's low-income children and working families is based in personal ideology, not reality. On a late Friday night in August, the administration sent a letter to all 50 states announcing unilateral changes to the rules for the SCHIP program. The president's proposed changes would immediately cut approximately 5,000 Connecticut's children from HUSKY B. Those unfortunate victims of an irresponsible White House policy change would join nearly 74,000 uninsured children in Connecticut.

Forty-three governors across the United States, including Connecticut Gov. M. Jodi Rell, support a robust SCHIP program and support the Congress' efforts. However, the White House refuses to embrace this carefully crafted, bipartisan measure that boosts funding by $35 billion for the next five years and adds 4 million more low-income children to the already 6.6 million children enrolled.

Elected officials aren't alone in supporting this legislation. More than 300 organizations, including the American Medical Association, AARP and the Catholic Hospital Association, support this reauthorization.

Congress is keeping its pledge to make this investment in accordance with "pay-as-you-go" rules so there is no additional federal spending added to the budget. This is good news to the American taxpayer and should have been welcomed by President Bush.

Children are the least expensive population to cover because much of their health-care costs are related to preventive care, rather than treatment for debilitating and chronic illnesses. This has the added bonus of creating long-term savings for our health-care system by introducing a healthier population into the mix.

We have an opportunity in front of us to give 10 million children in America access to the health care they desperately need and deserve for a healthy start to their lives. Instead, the president's priorities continue to be spending $10 billion per month in Baghdad to continue a failed Iraq policy, rather than a fraction of that cost to give children in Connecticut medical coverage.

But this is not necessarily a new fight the president has waged against America's low- to mid-income families. Families and students struggling to afford a college education saw critical Pell Grant funding essentially frozen from 2002 through 2006, while at the same time they were forced to pay increased student loan rates. For a White House that has argued the United States must be more globally competitive, that policy is just plain backward. We need more young adults to have access to an affordable education, not fewer.

It took a new majority with a greater vision toward the future to increase student aid programs, cut student loan interest rates in half and offer student loan forgiveness to those qualified students who choose a career in public service for 10 years after graduation without any additional tax burden on the American public.

And now, with that same look to the future, the Democratic majority is once again fighting for our most vulnerable citizens, our children, who have been grossly ignored by this administration.

Thursday, I will vote to override the president's veto, and I will urge my Republican colleagues to stand with me in a bipartisan effort to protect our children. The Democratic majority needs only a handful of visionaries from the Republican minority, who are willing to buck their party's leadership that has treated millions of children across the nation as political pawns.

I promise to continue advocating for Connecticut's children because the choice is really a simple one -- will we care for America's most vulnerable citizens, or ignore them? I will not ignore their needs.

Norwich Bulletin, 10/17/07

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

Courtney Pushes For 'Healthy Kids Act'

As printed in The New London Day, March 15, 2007:

There are currently 49,192 children in Connecticut who qualify for Medicaid or HUSKY health care but are not enrolled, says the American Academy of Pediatrics.

On Wednesday, U.S. Rep. Joe Courtney, D-2nd District, and House Democratic Caucus Chairman Rahm Emanuel of Illinois held a press conference to announce their push for legislation that would get those children the health care they need.

The bill, dubbed "The Healthy Kids Act," is a reauthorization of legislation first passed a decade ago, but with changes that would make it easier for children to enroll in health-care programs both in Connecticut and nationwide, where there are an estimated 6.8 million children who have no coverage.

Both Courtney and Emanuel said President Bush's proposed funding for children's health care would fall far short of what's needed.

While the independent Congressional Research Service estimates the program will need an increase of $13 billion to $15 billion over the next five years to maintain current services, Bush has only requested $5 billion over the next five years.

"The president's proposal would actually turn the clock backward," Courtney said. "We would literally be throwing thousands of kids out of the program if we adopted his proposal."

The proposed legislation would improve children's access to health care by streamlining the enrollment process and giving states a bonus - a 2-percentage-point increase in the federal funding match - for doing do, the congressmen said.

Emanuel outlined some of the ways in which states can streamline the process.

"Schools can be the best recruitment for getting kids into the program," he said. "If you're eligible for WIC or school lunches," the forms parents fill out for those services would automatically enroll the child in the health care program.

"By cutting down on bureaucracy you can enroll kids," said Emanuel. "You would automatically pick up millions of children by just making what they do everyday in the schools part of the enrollment."

The bill will also give families who are not eligible for Medicaid or HUSKY a "Healthy Savings Tax Credit" they could use to buy health coverage for their children.

Of the 73,421 Connecticut children currently uninsured in Connecticut, Courtney said, 49,192 would qualify for HUSKY coverage and the remaining 24,228 could get coverage through the tax credit.

Courtney and Emanuel said the bill had wide support from both sides of the aisle in Congress, so they are optimistic it will be passed.

"I think we're going to have a really strong bipartisan basis for support," Courtney said.

The Healthy Kids Act is expected to cost approximately $60 billion over the next five years.