Wednesday, October 31, 2007
Separating the SCHIP from the chaff
Elizabeth Strother
Recent columns
Surprised to see police officers, school nurses, teachers among the people in the Roanoke Valley who are looking for government-subsidized health insurance for their kids?
People who have a home to live in, pay their bills, put food on the table and clothes on their children's backs and send them off to school? People who look a lot like you?
Not your idea of people who are poor -- or poor enough, at any rate, to be less than self-sufficient?
The "new uninsured" who reporter Beth Macy wrote about in Monday's paper do not look like desperate denizens of an American underclass, and indeed they are not. They are, rather, hardworking, educated people who are getting by -- except in one area, the increasingly costly necessity of health insurance coverage.
They illustrate well the disconnect between perception and reality among the people -- public policymakers and in the general public alike -- who charge that the current push by a Democratic Congress to expand children's health care coverage will draw in families who don't really need the help, and cut into enrollment in private insurance plans.
These families don't have the luxury of choosing the State Children's Health Insurance Program and dropping their employer-based family insurance plan. If they're fortunate enough to have health care coverage available through work at all, they find they can't afford the employees' share of the cost to put their children on the plan.
Are they "poor" -- the word President Bush and his allies in Congress use as their supposed benchmark for SCHIP eligibility?
That is the wrong question to ask. Politicians should need no reminding that SCHIP is a work support, a joint federal and state program intended to offer children health care coverage if their family income pushes them into the lower middle class, too high to qualify for Medicaid, the federal/state health plan for the poor.
Are the "new uninsured" poor enough, then -- truly unable to acquire private health insurance for their children, whether through work or on their own?
They are in Virginia, where SCHIP goes by the name of FAMIS, the Family Access to Medical Insurance Security plan -- the better to differentiate it from Roanoke's CHIP, the nonprofit Child Health Investment Partnership, which predates the insurance program by some years. CHIP's aim is to promote the health of disadvantaged children. Among its array of services, it connects eligible families to FAMIS.
SCHIP is a federal block grant program that allows states flexibility in deciding how to cover their low-income, uninsured children. That flexibility is key: What is low income in Southwest Virginia is not the same as in, say, New York -- or Northern Virginia, for that matter. But no one can argue that FAMIS eligibility is too generous in the commonwealth.
Meschelle Bibby, an eligibility worker for CHIP of Roanoke Valley, explains that children can be covered whose families' gross monthly income is not more than 200 percent of the federal poverty level. Adults need not apply. FAMIS covers only children, with one exception: pregnant women.
If 200 percent of the federal poverty level sounds like enough to cover life's essentials, including insurance, you probably don't understand how inadequate the measure is by today's needs.
The poverty line was developed in the 1960s, based solely on the cost of food. At the time, spending patterns indicated that families spent, on average, one-third of their income on food. Numbers crunchers took the USDA's "thrifty food budget" figure, which varies by family size, multiplied by three, and there they set the poverty line.
It has changed over the years to reflect inflation, but not changes in family spending patterns -- and I'm not talking about discretionary spending here, but necessary spending that follows societal changes, including welfare reform. Working mothers need child care.
"It's crazy to be talking about people making 200 and 300 percent of the poverty rate and saying, 'Wow, these people are making a lot of money,'" CHIP Executive Director Robin Haldiman complains. "They're not."
The political jousting over expanding SCHIP has loosed a lot of misinformation that should not be allowed to obscure either the value of the program or the legitimate, unmet need.
The worst offense against truth has been the mindlessly repeated allegation that expanding SCHIP would allow more illegal immigrants to participate. Illegal immigrants never have been eligible, and the changes Congress has passed, and the president has vetoed, would not let them in.
Unexamined fear is the enemy of clear thinking.
Strother is a member of The Roanoke Times editorial board.
