It took more than a decade of constant agitation for the elderly to win the right to charge their prescription medications to Medicare. Republican reluctance to spend the money combined with a Democratic willingness to put off action so as to keep the issue in partisan play. The result was that it took a Republican president to undo the political knot and pass a plan that finally offered senior citizens some relief.
We are now watching House Democrats play the same partisan game with the renewal of the State Children’s Health Insurance Program (SCHIP), which expires on Sept. 30. Meanwhile, the Senate on the one hand and President Bush on the other appear to have crafted a generous extension of the program that may now fall prey to the House Democratic desire to provoke a presidential veto — and the children be damned!
Bush opened the game by proposing a $5 billion expansion of the program to cover more children and to limit the focus of the program to child health insurance. This highly successful program, initiated in the middle of the Clinton administration, has now succeeded in reducing the proportion of uncovered children to less than 10 percent (many of whom could get Medicaid if their parents bothered to apply). States have moved to use the program to expand coverage of adults without insurance and the Bush administration wished to restrict the practice.
But the Senate went further and is pushing a $35 billion program, financed by an increase of at least 60 cents in the federal cigarette tax. The extra money would bring the five-year cost to $60 billion. Crafted by Republican Sens. Chuck Grassley (Iowa) and Orrin Hatch (Utah) along with Democrats Max Baucus (Mont.) and Jay Rockefeller (W.Va.), the plan would make child coverage virtually universal and permit states to access food stamp and other assistance program data to locate uncovered children and bring them into the program. But it would restrict the coverage of adults.
Raising the tobacco levy is a good thing to do anyway, even if you don’t need the money. A higher cigarette tax has been demonstrably shown to cut teen smoking, and the increase, which would bring the total levy to $1 per pack, is a good step to improve national healthcare.
Bush threatened a veto, but seems to have backed off and appears able to live with the Senate bill.
So the House decided to pass a bill he couldn’t sign. By deliberately provoking a veto, they hope to demonstrate what a heartless Scrooge Bush really is.
Not only is the House upping the price tag to $50 billion, it is gratuitously courting the favor of the medical establishment by eliminating the cuts in physician fees scheduled for the next few years as part of the effort to save Medicare without cutting benefits. The House bill also opens the doors of the program wide to adult coverage. Covering adults is a good idea. It would be great to cover all Americans without having to fundamentally alter our healthcare system. That way, socialist utopians like Hillary couldn’t use the uncovered population as an excuse to make healthcare a government-dominated program.
But House leaders know full well that Bush won’t sign the bill that repeals his Medicare physician fee cuts and opens the program to adult coverage. But they are determined, nevertheless, to jerry-rig a bill that Bush can’t sign by festooning it with provisions that not only endanger the future of the Medicare program they profess to adore but also may kindle a new round of medical cost inflation they profess to abhor.
The House should just back off. It is a major accomplishment in healthcare, the new third rail of our politics, to expand SCHIP to cover all children. Forcing the administration to give up its hard-won gains on Medicare cost containment to swallow the program is deliberately unrealistic.