Children’s groups working to save measures in war bill

Children’s advocacy groups are making a last-minute push to save healthcare spending provisions for the next generation that are part of the war supplemental bill.

The groups are working to convince the House Democratic leadership not to strip provisions from the bill that would block Bush administration attempts to limit Medicaid and children’s healthcare spending.

{mosads}A House vote on the war spending supplemental could happen as soon as Thursday. As of Wednesday afternoon, lobbyists for children’s groups, hospitals and others are not certain whether these provisions, which have already passed the House or the Senate at least once, will remain in the bill.

President Bush opposes the attempts to block the spending limits, but those provisions make up a very small part of a bill that contains vital funding for combat troops in Iraq and Afghanistan — legislation the president has vowed to veto for larger reasons than the healthcare programs. Nevertheless, the healthcare language is at risk of being cut out of a war spending bill.

Groups in favor of blocking the administration’s policies are engaged in what could be their last shot at getting legislation through. The National Association of Children’s Hospitals (NACH), for example, has organized lobbying days Wednesday and Thursday, which feature visits to lawmakers’ offices by 30 families with children who have been treated in their facilities, many of whom are Medicaid or State Children’s Health Insurance Program (SCHIP) beneficiaries.

Although heavy hitters like the AARP and the American Hospital Association also oppose the administration policies, the groups more directly affected are the most concerned about missing an opportunity to see the administration’s policies prevented.

“The Medicaid program is incredibly important to children’s hospitals,” said Lawrence McAndrews, the president and CEO of the NACH. Children’s hospitals get about half of their revenue from Medicaid, he said.

Democrats and their allies in liberal advocacy groups, along with state governors and children’s groups, have railed all year about the administration’s Medicaid and SCHIP policies. The administration, in turn, points to the dire fiscal condition of entitlement and safety net programs and the effect that spending on them is having on the federal budget.

Last year, the administration put forth seven new Medicaid regulations aiming to establish stronger safeguards against escalating federal spending on the program, which is jointly financed with the states. The rules were the culmination of a years-long effort by the administration to restrict states’ abilities to use budgetary maneuvers to maximize the amount of federal money they receive. Together, the regulations would reduce Medicaid spending by about $15 billion over five years.

The Democratic legislation would postpone the effective date of these regulations until April 2009.

Democrats were more outraged, however, by the administration’s move to limit SCHIP enrollment, which came in the midst of heated negotiations between Congress and the White House over legislation to reauthorize the program.

On Aug. 17, 2007, the administration notified states of new guidelines on expanding SCHIP to children in families with incomes higher than 250 percent of the federal poverty level.

States, for example, have to demonstrate that at least 95 percent of children in families below that income level were already covered before being permitted to offer SCHIP to more children.

States also have to show that children would not give up private health insurance to join the public program. The SCHIP directive takes full effect on Aug. 17, 2008.

Democrats want to eliminate this directive and have argued that the administration overstepped its authority by putting it in place without legislative authorization or without going through the formal rulemaking process.

The administration’s efforts to rein in spending on Medicaid and limit SCHIP enrollment to children in the lowest-income brackets would lead to an increase in the ranks of the uninsured at a time when the economy is struggling, job losses are mounting and more employers are being forced to drop costly health benefits, according to proponents of the legislation.

“We’re going to see the uninsured rolls of kids continue to uptick,” said Bruce Lesley, president of First Focus , a children’s advocacy group. “This is already having an impact on kids,” he said. First Focus has worked to organize more than a hundred groups to lobby for the SCHIP provisions, including those representing counties, local school districts, nurses and a plethora of interests that would be affected by reduced Medicaid and SCHIP funding.

These core Democratic principles might become a casualty of political pragmatism on war spending, however, if the leadership decides to compromise with the administration and some congressional Republicans, which view the Medicaid and SCHIP policies as necessary to maintain the fiscal integrity of the healthcare safety net.

The problem, advocates said, is not a lack of support in Congress for maintaining Medicaid funding and freeing states to add to their SCHIP rolls. Rather, marrying these issues to an unrelated bill on war funding has complicated their prospects.

“On the whole, we have very strong bipartisan support,” McAndrews said.

Indeed, the House in April passed a standalone bill on the Medicaid regulations by an overwhelming 349-62; that language was later attached to the House-passed version of the war supplemental. When the Senate considered the war spending bill a few weeks later, the upper chamber added Medicaid and SCHIP provisions via an amendment that passed 75-22.

Last month, the administration indicated some flexibility in its enforcement of the SCHIP directive in a letter to states. In addition, the administration has communicated a willingness to postpone some, but not all, of the Medicaid regulations.

Congress could elect to include only a portion of the already-passed Medicaid and SCHIP provisions in the war spending bill.

That approach would not satisfy some advocates, however, Lesley said. By allowing even some of the administration’s policies to take effect, “Congress, in a funny way, is almost abdicating their responsibility to make the law,” he said. “They’re effectively allowing the administration to dictate almost carte blanche what goes into these programs.”