Enforced Uninsurance

Today's New York Times had a front-page article about efforts of the Bush administration to prevent states such as California from insuring children with medical care.

New federal regulations, released last Friday, require that certain children moving from private plans to state-sponsored programs must have at least a one-year period of uninsurance. Also, to prevent parents from trying to substitute public programs for private insurance, the Bush administration requires that copayments and premiums should be equivalent to private insurance.

These limits kick in if states wish to provide funding with the Children's Health Insurance Program (CHIP), a law passed in 1997 to help low-income children have health care. States such as California and New York have tried to expand this coverage option to those of incomes above the federal poverty level, and herein lies the rub.

The federal poverty level for a family of four is $20,650. Everyone agrees that this number is based upon faulty calculations, and comes from an earlier era in which housing cost a much lower percentage of income, while food cost substantially higher. We're living in a different time, and the poverty level calculation now vastly understates true purchasing power. However, no president wants to be the one to revise this poverty level and produce perhaps as much as a doubling of the poverty rate under his administration. So the fiction of this poverty rate calculation continues, even though all parties know it is a fraud.

The federal poverty rate doesn't take into account the vast regional differences in the cost of living. I have some friends living in Ohio who want to move back here, but cannot sell their beautiful 3 bedroom house for their asking price of $168,000. The median housing price in the Bay Area in April 2007 was $720,000. And if you're thinking that salaries in the Bay Area compensate for this difference, their move will involve a pay cut.

New York recently tried to allow children to enroll in the CHIP if their families earned as much as 400% of the federal poverty level. While this may seem like a circumvention of the point of CHIP--helping low-income kids--the level of qualification for enrolling in CHIP is based on the fiction of the federal poverty level.

The Bush administration now wants to force any child coming from a family with an income 250% of the federal poverty level to 1) wait one year before being enrolled, and 2) pay private insurance-equivalent copayments and premiums.

As an added catch, states wishing to enroll any children above 200% of the poverty level must prove they have enrolled 95% of below 200% children in the state. Not one state has achieved this to date, and according a Professor Cindy Mann of Georgetown, no state can achieve such an unrealistically high goal. Setting these pie-in-the-sky goals, such as the fantasy in No Child Left Behind of 100% of children performing at grade level by the 2013-14 school year--even if they are developmentally delayed, even if school rooms are falling apart, while school budgets are slashed--is endemic to an administration divorced from what is mocking calls "the reality-based community."

All this is just another sordid, embarrassing episode in the long national disgrace of our health care system. This byzantine, Kafkaesque labyrinth of regulations is well-designed to do one thing: To punish sick children for being poor. What kind of a president does that, and what sort of country are we if we allow it?


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