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After months of rhetoric, SCHIP expansion is scrapped entirely

December 26, 2007

Faced with the looming expiration of another short-term extension of the State Children’s Health Insurance Program (SCHIP), Congress this week officially threw in the towel on its yearlong attempt to expand the program, instead voting overwhelmingly to extend it in current form until March 31, 2009.

The proposed $35 billion expansion of the SCHIP was crafted and pushed extremely hard by Congressional Democrats seeking to expand federally funded health care and to score political points against Republicans, whom Democrat leaders thought to be vulnerable on health care issues. However, when House Democratic leaders responded to President Bush’s second veto of the SCHIP expansion plan by scheduling the vote to override or sustain Bush’s action for January 23 – six weeks from the December 12 veto – rather than calling for immediate action (their only other choice according to House rules), failure on the proposed expansion became all but a foregone conclusion.

“Republicans will stick together and...will sustain President's veto,” a highly-placed House staffer told me shortly after the President Bush sent the SCHIP legislation back to Congress. “We'll have enough votes for that.”

Realizing that they again would not be able to raise enough votes to override Bush’s veto – even given six weeks to lobby Republicans perceived to be vulnerable on the issue to switch sides – Congressional Democrats ended their vigorous attempt to expand SCHIP. In the end, instead of expanding the program by $35 billion, Congress simply voted to extend SCHIP in its current form once again. However, unlike previous extensions, which were purposely brief so as to keep the issue on the front burner in Congress and in the media, this time the program was extended for sixteen months – a move which clearly demonstrated the majority’s unwillingness to further address the issue within the current Congress or with the current administration.

Further, according to Reuters, “Democrats had hoped for a short-term extension of the program so they would be able reopen the battle before the November 2008 presidential and congressional elections.” Clearly, the Democrat leadership realized that what had previously looked like a winning issue for the party was not as much of a legislative and electoral slam-dunk as many had thought. The White House, as could be expected, reacted to this development favorably. We are pleased that the Congress passed legislation to extend SCHIP until March 31, 2009 – and did so without raising taxes,” said White House press secretary Dana Perino. “With this bill, we can be assured that children will continue to have coverage, and Democrats won't be able to play election-year politics with children's health.”

Even more impressive than the fact of the majority party’s public surrender on SCHIP expansion, though, was the speed and completeness of the act. Less than a week after falling victim to Bush’s veto pen for a second time on the same issue, the Senate had passed the fifteen-month extension by unanimous consent, and the House had approved it by a 411-3 vote. When the hysterical tenor of several floor speeches on the topic, which included asking “How many children will be dead” if the President were to veto the SCHIP expansion, is taken into account, the totality of the majority party’s surrender becomes that much more pronounced. Judging by “the Democrat rhetoric earlier this fall,” a highly placed Republican staffer told me, it was clear that “they were confident of massively expanding the program.” Not only did that “not occur in any way,” but there weren’t even “able to generate public support for their proposals.” Tellingly, the final outcome on the issue was a de facto 511-3 vote in favor of simply extending the current program – a result which suddenly shows surprisingly little concern for the question of “how many children will be dead” thanks to the incredibly weak majority’s acquiescence on the issue.

Also included in the bill was an emergency extension of current pay rates for doctors serving Medicare patients. The 10% physician pay cut that had been scheduled to go into effect at the beginning of 2008 had caused many doctors to consider recouping that lost income from their non-Medicare patients, or dropping Medicare patients from their caseloads altogether. The reduced compensation would not be “enough to keep pace with the escalating cost of doing business,” according to the American Medical Association.

Dealing with the looming dip in doctor pay, which is tied to the economy, is an annual exercise, which receives “quick fixes” every year. Unfortunately, simply applying another band-aid just serves to “compound the problem,” according to a spokesman for the Ohio State Medical Association.

Under the bill passed this week, pay for doctors treating Medicare patients will increase 0.5% on January 1. That level of compensation will last until June 30, at which time the scheduled rate cut will occur. However, unlike SCHIP, lawmakers plan to address the Medicare situation early in 2008. "The purpose of moving forward with a six-month package now,” said Sen. Charles Grassley (R-IA) “is to provide the opportunity for the Finance Committee to address these priorities next year.”

The same cannot be said for the State Children’s Health Insurance Program. An emotional issue which the majority party kept on the front burner for so many months this year, the prospect of expanding SCHIP beyond its current scope has, in the end, been passed off to another Congress – and to another President.

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