Missing Children

The story behind the story on SCHIP

Last week, the House passed a long-awaited bill that would increase the number of kids covered under the State Children’s Health Insurance Program (SCHIP). The coverage was predictable. Republicans grumbled, making the same arguments they made when Congress tried to expand the SCHIP twice before: The Democrats were promoting government-run health care; the program was too generous, covering kids from families with higher incomes. The Dems countered with a sound bite calling passage a down payment for further health reform. The AP passed the sound bite along. The President-elect himself said this after the vote:

In this moment of crisis, ensuring that every child in America has access to affordable health care is not just good economic policy but a moral obligation we hold as parents and citizens.
With a quote like that and cursory press accounts, the public can be forgiven if it thinks it got the whole story on SCHIP and that every child in need would soon have health insurance. Some stories got mired in the issue of whether children who are legal immigrants and have been in the U.S. for less than five years should be eligible (the House, according to The New York Times, says yes; the Senate no). Others highlighted the politics of passage. Sen. Charles Grassley, a key Republican on health matters, was miffed because his Democratic rivals “violated a spirit of bipartisanship.”

A lot of the coverage, though, missed a more important point. The bill omits about half of the children who have no health insurance. The Los Angeles Times and Reuters got it, noting that covering four million new kids would “nearly halve the number of uninsured youngsters in the country,” but too many stories failed to offer that context.

In 2007, when SCHIP reauthorization first surfaced, the House had intended to cover five million of the approximately nine million uncovered kids, two-thirds of whom were eligible for either Medicaid or SCHIP. But when it became clear the Senate wouldn’t go along, the House bowed to the Senate’s version, which called for covering only four million. At the time, a spokesperson for the Center for Budget and Policy Priorities remarked: “It’s very frustrating to see a phenomenal House bill and then move toward the Senate bill.” It was essentially the Senate bill, twice vetoed by President Bush, which sailed through the House last week.

The Washington Timesraised another question: How much of a down payment is really being made? The paper reported the Democrats’ claim that “under the bill no new waivers to cover parents of children that receive SCHIP benefits would be issued. And childless adults who are covered under the program no longer would be eligible.”

OK, here’s the translation—and why it’s important for health reform. In order to encourage more kids to apply for SCHIP, some states learned over the years that offering coverage to their parents was a big enough carrot to get them to apply for kids’ coverage too. Through waivers encouraged by the Bush administration for alternative uses of SCHIP money, eleven states covered parents, four covered childless adults, and eleven covered pregnant women through an option to define the fetus as an unborn child. The Deficit Reduction Act, passed three years ago, put an end to new waivers for childless adults.

So does the SCHIP bill mean that those childless adults still covered will now lose their insurance? And what about the stimulus package? “People who lose their jobs might be able to go on Medicaid,” says Marilyn Moon, a vice president at the American Institutes for Research and an expert on Medicare and Medicaid. “Those people are likely to be childless adults.” During the campaign, the new president and his surrogates talked a lot about building on the public/private arrangement that characterizes U.S. health care. That is what states were trying to do. Do provisions tucked into the bill soon to land on the President’s desk (and overlooked by the media) mean that, instead of building, a dismantling is taking place? Says Moon: “We may not get to universal coverage right away, but the first principle should be: Do no harm.” Health reporters, take note.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.