The Winston Group is a strategy and research firm dedicated to making ideas matter.

Open, Honest Health Care Discussion Is Needed

by David Winston

It’s déjà vu all over again with a familiar political formula: Democrats set up a legislative straw man, or more accurately a straw child, with which to portray Republicans as callous misers whose largess extends only to those who don’t file the short form.

In the mid-1990s, the albatross that Democrats hung around the collective necks of Speaker Newt Gingrich (R-Ga.) and Congressional Republicans was the federal funding of the school lunch programs for low-income students. Republicans actually increased funding for the program, but Democrats were able to successfully characterize the proposed Republican funding increase as a cut. Republicans lost that public relations battle. After the disastrous 2006 elections, the GOP can’t afford to lose another one.

This time around, the straw man is the State Children’s Health Insurance Program, which both the White House and Congress agree needs to be expanded. That’s where the agreement ends.

President Bush has proposed a $5 billion or 20 percent funding increase for low-income children without health insurance today, hardly a miserly boost.

Not surprisingly, Democrats want a $35 billion hike — or do they? Yes, Speaker Nancy Pelosi (D-Calif.), in one of her most disingenuous moments to date, told reporters, “It was with great friendship that I reached out to the president this morning to say that I was still praying that he would have a change of heart and sign this legislation.” That comment ought to rate a spot in the cynical sound bite Hall of Fame.

Democratic Caucus Chairman Rahm Emanuel (Ill.) probably came closer to the truth when he talked out of school, telling The New York Times, “If [Bush] vetoes the bill, it’s a political victory for us.”

Maybe Pelosi ought to pray that Emanuel stops talking to the media. Republicans, however, ought to focus their effort to counteract Democratic spin on a very simple argument.

First, SCHIP was designed to ensure that low-income children — repeat, children — who don’t qualify for Medicaid are able to get health insurance.

Second, when the program is abused by including adults, insured children and families far above the poverty level, fewer poor children can benefit from the program.

Speaking recently at Harvard’s Kennedy School of Government, Health and Human Services Secretary Mike Leavitt told students, “The intention of SCHIP was to focus on the poor, it was not intended as a vehicle for expansion to every American.”

But that seems to be the hidden agenda of many supporters of the Democrats’ proposed SCHIP expansion. They claim that their proposal will add 4 million more Americans to the ranks of the insured.

What they don’t say is 1.2 million already are eligible for Medicaid but simply have failed to sign up for the program. Almost another 2 million are above the poverty level requirements of the program, and the majority of those already have private health insurance. Spending $35 billion to cover 900,000 children makes one wonder where the money is going. You don’t have to wonder long.

Some 14 states already use SCHIP funding to provide health insurance to adults. In fact, 13 percent of this year’s SCHIP funds will pay for health insurance for adults. For example, Wisconsin currently uses 75 percent of its SCHIP funds to cover almost twice as many adults as children. Many other states spend significant portions of their SCHIP funding for adult coverage.

What Democrats really are proposing is an incremental, backdoor approach to universal health care by including many middle-income children who already have private insurance. Emanuel himself admitted as much when he called the SCHIP debate “spring training” for the inevitable battle over universal health care at a Judiciary Committee Congressional Forum on Universal Health Care with Single Payer Financing in April.

What happened to the Democrats’ cries that SCHIP is all about “the children”? Clearly, by Emanuel’s own words, the SCHIP battle is nothing but a stalking horse for universal health care. Republicans need to understand the politics behind the Democrats’ SCHIP strategy.

But that’s not enough. They must offer an alternative that addresses the need for all children under 18 to have health care insurance either through their parents or through SCHIP and Medicaid. That may mean upping the president’s $5 billion ante. But it ensures that the political debate focuses on the right question: not whether Republicans are willing to ensure all children in America without insurance get coverage, but why Democrats want SCHIP to cover adults and children who already have insurance.

People want and deserve an open and honest dialogue about how each party’s proposals will address the problems of health care coverage, access and funding for all Americans.

What the country and certainly poor children don’t need is the leadership of the majority party trying to score political points by exploiting the health care vulnerabilities of low-income children just as they did with the school lunch program appropriations a decade ago.

PDF Version