Congress should reauthorize, expand children's health insurance

Eleven percent of children in the United States -- about 8.6 million -- are not covered by health insurance. That's according to the Princeton, N.J.-based Robert Wood Johnson Foundation.

The percentage of children without health coverage of any kind is even higher in Oklahoma, about 14 percent. That translates to 127,000 children uninsured in Oklahoma.

This means that if these children get any kind of medical treatment in a year's time -- and as many of a third of them don't -- it is most likely through hospital emergency rooms. That is the least efficient and most costly way to deliver primary health care. And of course the unreimbursed costs of such care are ultimately paid by insured or self-pay patients.

As bad as the number of uninsured children are -- and they are a national embarrassment -- they are much improved from a decade ago, before Congress enacted the very successful and popular State Children's Health Insurance Program.

The program, usually referred to as SCHIP, was designed to reach children in families of the working poor, those who earn too much to qualify for Medicaid but who don't have employer-provided insurance and can't afford private coverage.

The number of uninsured children nationally dropped by about 3.4 million from 1998 to 2005. In Oklahoma, where SCHIP funds pay for much of the SoonerCare program, the ranks of children without health insurance declined from 18.9 percent to 14 percent over the same period.

SCHIP has brought health coverage to more than 50,000 Oklahoma children, according to Georgetown University's Center for Children and Families.

Funding authorization for SCHIP, which was originally passed by a broad bipartisan majority in a Republican-controlled Congress, will expire Sept. 30 if the program is not reauthorized.

There is a fly in the ointment. President Bush has threatened to veto a SCHIP reauthorization bill sent him by Congress if it includes an increase of more than the $5 billion he proposed.

The Senate and House have passed differing versions of a reauthorization bill. The Senate version would extend the program to 3 million more uninsured children and add $35 billion over five years. The House passed an even bigger and more costly measure that would increase SCHIP by $50 billion over five years. Both measures are far over the limit at which Bush said he would veto the reauthorization.

The Senate version is reasonable and justifiable. The $35 billion increase supported by the Senate is, obviously, a lot of money although not so much compared to the amount spent every few months on the wars in Iraq and Afghanistan.

The Senate vote, 68-31, was large enough to be veto-proof, which means that there is a good chance that the Senate would vote to override a presidential veto. The vote on the more costly House plan was not veto-proof.

It is disappointing that efforts in Congress to reauthorize and expand SCHIP have been accomplished to date without the help of any member of the Oklahoma delegation, all of whom voted against it. Are they unaware that Oklahoma has propor tionately more uninsured children than all but a half-dozen other states and thus stands to benefit more from an expanded SCHIP?

The State Children's Health Insurance Program is a federal program that works. It has increased the number of American children who receive primary health care and vaccinations before they get seriously ill. It keeps them out of emergency rooms for problems that shouldn't become emergencies. Finally, it helps keep them in school, with a better shot at academic success.

Congress and the president ought to not only reauthorize SCHIP but expand it to something close to the level favored by a broad bipartisan margin in the Senate. And Oklahoma's delegation ought to join in.

David Averill, 581-8333
david.averill@tulsaworld.com