S-CHIP showdown: Policy clash or political pawn?

President Bush engaged Congress this week in a D.C. showdown over S-CHIP, the State Children’s Health Insurance Plan.

According to the White House Press Office, Bush warned months ago that he would veto an expansion of S-CHIP much beyond the $5 billion, or 20 percent, he had proposed. But given that Bush has spent heavy political capital defending the Iraq war and that health care reform is a big issue ahead of next year’s elections, Democrats seized the opportunity to go to the mattresses with the president on it.

On Wednesday, Bush made good on his threat to veto the program’s reauthorization legislation, which featured a five-year, $35 billion expansion that would have made the government’s health insurance program available to 10 million more children per year.

Following the veto Wednesday, Bush said that the expansion went against the original purpose of S-CHIP, which was to help make health insurance available to poor children; the expansion, he said, would make government coverage available to children whose families earn up to $83,000, or four times the federal poverty rate. As such, it is believed that one in three new S-CHIP enrollees would leave the private insurance market for the government plan, creating a staggering weight under which the program would eventually collapse, the administration said.

Democratic congressional leaders have set Oct. 18 as the date they will try to override the veto. They have enough votes in the Senate, they say, but need between 15 and 20 in the House.

Readers of this space may remember that three weeks ago, I questioned whether Bush would have needed Gen. David Petraeus’ full-court public relations press on Iraq if the administration would have consistently communicated its policies to Americans over the last five years, instead of here and there when funding bills were under consideration. It seems that the administration’s lack of communication is again an issue with S-CHIP.

S-CHIP isn’t perfect, even before expansion. It’s estimated that a half-million children are eligible, but unenrolled, under existing guidelines. But what about those kids whose families clear the current ceiling for S-CHIP eligibility of $41,300, or 200 percent of the federal poverty rate, but earn less than the amount needed to make private insurance truly accessible?

There’s merit in guarding against such a major expansion to a government program, especially one that involves a shell game that would leave the program 80 percent unfunded in year six, as the administration said the bill did. Bush said Wednesday that he is “more than willing to work with members of both parties from both Houses, and if they need a little more money in the bill to help us meet the objective of getting help for poor children.”

And what is that amount? Isn’t that where the debate should have been? The New York Times noted in an editorial last week that a recent analysis of census data found that the number of uninsured children jumped by 710,000 last year; in addition, almost half of the increase was in families with incomes between 200 percent and 399 percent of poverty — “the very group the administration seems to believe is adequately insured and has no need of S-CHIP,” the editorial said.

Regardless of what happens on Oct. 18, this issue isn’t going away: the Times reported Wednesday that the Democratic Congressional Campaign Committee has already begun radio ads and automated phone calls against eight Republicans in swing districts.

It makes you wonder, doesn’t it, whether the S-CHIP reauthorization is really about children’s health insurance at all.