Congress Eyes Expanding Children’s Health Insurance
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JIM LEHRER: Next, providing health insurance for children, and to Gwen Ifill.
GWEN IFILL: The battle over spending on health care for children comes to a head on Capitol Hill this week. The State Children’s Health Insurance Program is up for renewal. At stake is government-backed health care coverage for roughly six million poor children and, in some states, nearly 600,000 adults.
The House bill proposes adding $50 billion to the program over the next five years, the Senate about $35 billion more. Either plan would represent the biggest expansion of health care coverage in a decade. President Bush, however, says they are too expensive and has threatened to veto either measure.
We look at the arguments from both sides, beginning with the secretary of health and human services, Mike Leavitt.
Welcome, Mr. Secretary.
MIKE LEAVITT, Health and Human Services Secretary: Thank you.
GWEN IFILL: Why is it that the president wants to veto this legislation?
MIKE LEAVITT: The president desires to have the State Children’s Health Insurance Program reauthorized. It’s very important; he’d like Congress to do it soon. We think it’s an important program. We want to make certain that no child who’s currently covered by the program or eligible for the program loses that eligibility.
What he objects to is using this program or its reauthorization as a chance to expand dramatically the number of people who have federal health care. He believes that, while every American needs access to an affordable basic policy, that there are better ways to do it than to put people who make $80,000 a year on welfare.
GWEN IFILL: Let’s take that bit by bit. But start first, you said the president is interested in reauthorizing this program, but just not the way Congress is proposing. What would he propose instead?
MIKE LEAVITT: Well, he’d like to continue the program as it currently is. We think it’s been successful. We’d like to assure that no child who is currently eligible would lose that eligibility. And we would like to then move to a larger debate, which would be, how can we make certain that every American, including children of every income, have access to a basic insurance policy they can afford?
GWEN IFILL: I believe the president’s proposal would come to about $5 billion, but the Congressional Budget Office says it would cost $14 billion just to cover the number of people who are covered now. How do you reconcile those two numbers?
MIKE LEAVITT: Well, actually the president’s proposed just under $10 billion, which we think is adequate. If the number is wrong to cover our policy then we’re obviously willing to discuss that.
The number isn’t what’s important. The number — what’s important is that we agree on what this government program is intended to do. The president believes it should cover those children who are poor, not those who are moderate-income or, in some cases, higher-income brackets.
Covering moderate-income families
GWEN IFILL: In what instances is this program covering children who are in moderate- or higher-income brackets?
MIKE LEAVITT: Well, both of the proposals in the House and in the Senate would cover families that make as much as $80,000 a year for a family of four. That would expand to include people who are 25 years of age instead of 18.
There are many dramatic expansions here into areas people who are not necessarily in low income. This was intended to be a program for low-income children, and the president wants it reauthorized. He'd like to do it soon. He wants to do it quickly, so that we don't have any chance that the coverage of those children could be jeopardized.
By tying this dramatic expansion of government-run health care to the reauthorization, the Democratic leadership of Congress puts that at risk.
GWEN IFILL: And some Republicans in Congress, as well, who are supporting this, including Senators Grassley and Hatch, right?
MIKE LEAVITT: Well, they have supported a compromise in the Senate, but keep in mind that there is a very large expansion in the House. And there's no telling at this point what it will actually look like.
What the president has made clear is that he wants to reauthorize this program, wants to do it soon, but does not believe this is the appropriate way for us to make sure that every American has access to insurance. And that's the debate we ought to have: Every American needs access to insurance, not just children.
GWEN IFILL: You use this term "government-run health care" a few moments ago. Do you think that this is basically the camel's nose in the tent toward a universal health care coverage idea?
MIKE LEAVITT: Well, those who propose it don't make any effort to hide their fact that they would like Medicare or government-run health care to cover everyone in the country. Medicare has been an important program, as has SCHIP, but let's also remember that it was focused on those who are in need. If we use it as a tool to cover everyone, the dramatic problems that we have in meeting the demands, the fiscal demands of the entitlements would be expanded.
I'm a trustee of Medicare, and we issued a warning, saying this system cannot be sustained. It is financially in deep trouble. And then to use it as the means by which we would continue to cover people would be a very serious mistake.
GWEN IFILL: Some people listening to you might be a little confused at this point. You said that you support government -- universal access to health care, which you distinguish -- how is that different, in your estimation, from universal health care?
MIKE LEAVITT: Well, here's what I believe and the president believes. In this country, every person ought to have access to an affordable policy. If you are elderly or disabled or poor, the government ought to provide you coverage through Medicaid or Medicare or SCHIP, just like we do now.
Everyone else deserves to live in a state that has been -- where the market has been organized so that they can get a policy either through their employer or as an individual that they can afford. If they can't afford it, then we ought to help them buy it.
Every American needs access to an affordable policy. We ought to use Medicaid and Medicare and SCHIP to help those who have hardship.
Funding through a tobacco tax
GWEN IFILL: Do you have any problem with the funding proposals that would pay for this expansion in the House and the Senate bills, which is primarily the tobacco tax?
MIKE LEAVITT: Well, what we are proposing is the reauthorization of the bill, and the president's put forward a proposal to do that. It would not require tax increases. It would allow us to cover those children who are in hardship, and it would allow us then to turn to the larger debate, which would be, how can we get every American covered by an insurance policy and not have to do it with tax increases?
GWEN IFILL: So you oppose the tobacco tax increase that's proposed?
MIKE LEAVITT: Well, I don't do tax policy at the Department of Health, and, obviously, we'd like people not to smoke, and we want them to have health insurance. And we believe that there are better ways to do it than to put families who make $80,000 a year on public assistance.
GWEN IFILL: The administration is as good as nose counting on Capitol Hill as anyone. Do you know, if the president does veto either or both of these proposals or some combination of them, whether that veto can be sustained?
MIKE LEAVITT: Well, we're optimistic that they will be sustained, and it's an important debate. It's time that we not only debate the Children's Health Insurance Program but time that we get onto the discussion of how we can have every American with access to insurance policies that they can afford.
And we can accomplish it. We can accomplish it in a short term. The Congress not only needs to reauthorize SCHIP, so that poor children have help, but we need to do things that will make it possible for states to organize their markets where every American can have insurance policies.
GWEN IFILL: And would a veto be politically tenable?
MIKE LEAVITT: I'm sorry?
GWEN IFILL: Would a veto be politically tenable?
MIKE LEAVITT: Well, the president's resolved to get good policy, to get the right law. And the right law is to reauthorize this and to do it soon so that no child ever has to worry in September that their policy isn't going to be there for them. We want poor children to be covered. We'd like every American to have access, but we think we need to get onto the broader debate, once we've reauthorized SCHIP.
GWEN IFILL: Health and Human Services Secretary Mike Leavitt, thank you very much.
MIKE LEAVITT: Thank you.
Response from Gov. Pawlenty
GWEN IFILL: And now for a response, we turn to Republican Governor Tim Pawlenty of Minnesota, the incoming chair of the National Governors Association. He was one of a bipartisan group of governors who sent a letter last week to President Bush pressing for expansion of the health care program.
Welcome, Governor Pawlenty.
GOV. TIM PAWLENTY (R), Minnesota: Thank you, Gwen. Thanks for having me on the show.
GWEN IFILL: We just heard Secretary Leavitt say that this is basically a big expansion of a government-run health care program and that the president will veto it. What's your response to that?
GOV. TIM PAWLENTY: Well, our hope is this is an opportunity for the Congress and the administration to come together on a need that is obvious and an opportunity that is actually positive. There's great support for this program.
And while Secretary Leavitt has some concerns about dramatic expansions, we as governors also want to make sure that the current population -- and hopefully some reasonable expansions -- could be covered. And so I hope the two sides can come together and find a compromise without a showdown and nothing getting done; that would be unfortunate for the many, many disadvantaged children that this program serves across the country.
GWEN IFILL: Tell us about how many children or how many children and adults, if that's the case in Minnesota, are affected by this program in your state?
GOV. TIM PAWLENTY: Well, nationally we have about 6.6 million children who are insured. I don't have the number right offhand for Minnesota. We have some other state programs that supplement our children's insurance in Minnesota, as well.
We're relatively fortunate here, because 93 percent of our population has insurance. It gives us one of the lowest rate of uninsured in the country. But even in Minnesota, this SCHIP is an important part of our overall kind of quilt of programs here, and it needs to be reauthorized. So we hope that the Congress and the administration will come together and find a compromise.
GWEN IFILL: Forty-three governors sent this letter to President Bush asking him to support reauthorization and expansion, if possible. What kind of response have you gotten?
GOV. TIM PAWLENTY: Well, I think the response that we've received is the general expression of concern that you heard from Secretary Leavitt a moment ago. And I don't mean to discount or disregard those. If he's accurate in saying a family of four of $80,000 in income would qualify for SCHIP, that may mean that some governors could qualify for the program, or close to it, if they have a couple children.
So, you know, that's a fair point and something that should be considered. But, you know, as you mentioned earlier, the estimates are that it will take $14 billion just to insure the kids who are already on the program, and so, you know, the administration's position is something that we hope that they would loosen up on a little bit and have some room for expansion in it, as well.
GWEN IFILL: Does the bipartisan nature of support for this program give you any hope or given you any sign that there is some middle ground to be found before this ends in a standoff over a veto?
GOV. TIM PAWLENTY: I sure hope so. You know, the country is tired of gridlock and bickering and head-butting at the Congress and in the capitals across the country. And each side should realize that getting something, half a loaf is better than no loaf at all.
It's a popular program with bipartisan support. It shouldn't be rocket science for the leaders of the two perspectives to find a middle point that they can live with and serve the children in this country better as a result. So, yes, I think to answer your question, I'm optimistic and hopeful that that will happen.
GWEN IFILL: What do you say to Secretary Leavitt when he says that this is a step in the direction of universal health coverage and that the people who are supporting it are basically in favor of the government stepping in completely?
GOV. TIM PAWLENTY: Well, it really depends on what version you're looking at. I think even Secretary Leavitt said nobody really knows what the final bill is going to look like.
Again, of the positions, $5 billion or $10 billion that the administration is proposing, $35 billion in the Senate, $50 billion in the House, there's points in between, and just to cover the kids who are already on this program, estimates are $14 billion, and then, again, we hope that there would be some at least modest expansion beyond that.
So you don't need to have the Cadillac. Most people I think would be reasonably satisfied with the Buick or the Pontiac in this situation.
Funding alternatives for S-CHIP
GWEN IFILL: Let me ask you about the funding alternatives. One is a tobacco tax. There are numbers going back and forth I think between 49 cents a pack, 61 cents a pack. Do you think that that's the right place to get the money?
GOV. TIM PAWLENTY: Well, on behalf of the National Governors Association, speaking for all of the governors, which is a bipartisan group, you might imagine that we have a full range of opinion about that. And so we decided it's not our place to tell them what to do with the tobacco tax, but we are advocating for sustaining and expanding the program. But on behalf of the NGA, the National Governors Association, we have stayed out of the tobacco tax debate.
GWEN IFILL: How about another funding alternative, which would then -- in the House version, which would cut aid to Medicare insurers in order to underwrite this program? Is there any pitting of the old against the young with that kind of a solution?
GOV. TIM PAWLENTY: Well, those reimbursement rates for Medicaid or Medicare providers are already pretty low. And many providers say that it's a discouragement or, in some cases, a deterrent to even participate in the program because the reimbursement rates are pretty low already. There may be a little you could get out of those pots in certain instances, but I don't think that's a long-term or sustainable answer to fund the program.
GWEN IFILL: So what do the governors do now? Are you just standing off to the side and hoping that everything gets worked out, or do you have a proposal that you're going to put on the table that you hope will make sure this doesn't all go off the rails?
GOV. TIM PAWLENTY: Well, no, we're not just standing on the sidelines. Individual governors are making calls to their senators and representatives. Certain governors are willing and ready to go testify at Congress. So we're lobbying and advocating.
And some states, by the way, have a very acute timeline here. They're really at risk of running out of money. They don't have carryover money or reserve money, and so there are some states where this is really a right-now issue.
But governors are engaged. They're concerned. And this is the number-one thing that came up at our governor's conference a few weeks ago. And there's almost a complete unanimous viewpoint that this program is important, it needs to be reauthorized and soon.
GWEN IFILL: Well, I guess what I don't get, though, is what the solution is right now. There's a wide gap between what even the House and the Senate are proposing, let alone what Congress and the White House are calling for. It seems like it cries out for someone to step in the middle and come up with a middle ground, but I don't hear one coming from you.
GOV. TIM PAWLENTY: It would be very refreshing. And the governors have not put, at this point -- we may as the debate unfolds further -- a specific marker out there about a dollar number or an eligibility level. But this is a wonderful opportunity on a popular issue, where everybody could feel good, for the Republicans and the Democrats to come together, and, you know, lay down the outliers on their viewpoints, and just find a common ground and, for the good of the country, do it.
We need it. We need unifying moments in this country, and this is a great chance for that to do it. So governors will weigh in, I'm sure, in more detail as this unfolds, but our hope is that the program will be reauthorized.
GWEN IFILL: Let me ask you the same question I asked Secretary Leavitt about the politics of this. Is it politically tenable or sustainable at all for the president to veto what you describe as being such a popular program?
GOV. TIM PAWLENTY: Well, you know, having been somebody in an executive position, certainly not at the level of the president, but at a governor of a modest-sized state, I've had to veto a lot of things that were popular but just were not within our budget. And so that's never pleasant or easy, but sometimes you have to do it to send a message. I hope it doesn't reach that point with SCHIP.
GWEN IFILL: Governor Tim Pawlenty of Minnesota, thank you very much.
GOV. TIM PAWLENTY: You're welcome.