It’s a late summer dispute that may or may not be resolved before the American Congress joins the Iraqi Congress (“its hot in Baghdad”) in August recesses.
On its face, it doesn’t appear to be much of an argument, just the matter of the size, not continuation, of the popular, ten-year old State Children’s Health Insurance Program that currently insures 6.6 children nationwide. These are children who are not eligible for Medicaid, but live in families that cannot afford health insurance.
But then one realizes something more must be going on. There are some big dogs in this fight. President George W. Bush and health insurance and tobacco companies are on one side, and the Democratic Congress (and some Republican senators up for reelection), the American Medical Association and advocates for children and elderly on the other.
First, the dispute about size. Bush is agreeable to a $6 billion a year, $30 billion five-year program. The House and Senate respectively want $7 and $10 billion per year. The House bill would provide insurance for 3.2 million children among 9 million estimated to be currently uninsured.
Bush is very clear. He doesn’t want anyone getting government subsidized health insurance who can even marginally afford private insurance. So he threatens to use his veto pen, usually reserved to stymie government support of stem cell research, to stop this legislation. If Bush vetoes the bill, the game is over for now, because Republicans in the House would sustain the veto.
End of column? Not quite, because this doesn’t explain why the AARP and AMA are using TV ads to urge you to contact your Congress member to support the congressional bill.
The problem is the Democratic Congress has provided mechanisms to pay for the bill, and paying as you go is an anathema to Republicans (see $12 billion per month Iraq War). And, in this bill paying as you go also whacks Bush’s friends and sponsors, the tobacco and health insurance companies. Re tobacco: the House and Senate Finance Committee (by a vote or 17-4) propose increasing the federal tobacco tax from 61 cents a pack to $1. Hence, mobilization of tobacco lobbyists.
The balance of the financing for SCHIP would come from cutting current Medicare subsidies for HMOs and health insurance companies. This would put a damper on a long time Republican dream that would do away with Medicare as we know it, and make all Medicare enrollees dependent on the whims of insurance companies..
It’s so outrageous, you won’t believe it. But today Bush’s Medicare office pays insurance companies 112% of average regional Medicare costs for each Medicare recipient they can enroll. This overpayment makes it possible for insurance companies to offer some additional benefits to entice patients into Medicare Advantage--now 8 of 45 million.
Republicans are also whacking regular Medicare patients by reducing private physician fees, eventually by an intolerable 40%. This hellacious plan would make certain new Medicare patients, or those trying to flee insurance company HMOs and PPOs, will be unable to find a private doctor. Checkmate.
Not surprisingly, Congress is canceling the upcoming cuts in doctors’ fees as well as cutting insurance company subsidies, nearly restoring Medicare to its status before 10 years of Republican battering--and resulting in AARP and the AMA starting supporting ads this week.
That Bush and Republicans in the House are still able to support demolishment of health care programs for the elderly, and totally and permanently disabled --and make it stick--emphasizes once more the importance of the November, 2008 elections.
It is not only important to elect Democrats to make health care available to more children and deserving Americans, it is important for them to be able to reverse Republican legislation already on the books to enrich health insurance companies by handing them 45 million Medicare recipients.
When Republicans opposed Medicare and Medicaid over 40 years ago, they meant it. What is going on in Washington this month confirms the decider in the White House, and remaining Republican ideologues hunkered down in House bunkers still mean it.
Dr. Roy may be reached at email@example.com