Insuring children

The Bush administration has chosen to avoid a confrontation with several states over their expansion of the State Children's Health Insurance Program.

More than a dozen states, including New York, have expanded, or hope to expand, coverage under the joint federal and state program to families with incomes above 250 percent of the federal poverty level, or $44,000 for a family of three.

About 6.6 million people are now enrolled in SCHIP, which offers insurance to children in families with incomes too high to qualify for Medicaid but unable to afford the cost of private coverage.

The Bush administration opposed the state proposals as a costly expansion of the program that would see the costs of private health insurance shift to public programs.

The administration responded with two guidelines directed at limiting that potential shift. Children would have to be uninsured for at least a year before they could be enrolled, and states must ensure that at least 95 percent of poor children are enrolled in SCHIP or Medicaid before the program can reach out to middle-class families.

Governors and state leaders objected that they could not meet the guidelines, which would leave millions of children uninsured. In some states, complying with the directive might even have meant reducing existing programs.

The one-year mandate was aimed at preventing those who now have more costly insurance than SCHIP from moving coverage into the public program, which is not unreasonable. However, the time limit overlooks other factors such as loss of employment or economic hardships that cause families to lose private coverage.

Earlier this year, the Government Accountability Office said that the administration did not have the authority to impose the new rules which were a "marked departure" from the longstanding interpretation of federal law. As such, they had to be submitted to Congress for review before taking effect.

The administration has not backed off its restrictions but has chosen not to force the issue. Instead, Jeff Nelligan, a spokesman for the Centers for Medicare and Medicaid Services, said it will work with the states in question to ensure that the "most vulnerable, low-income children are covered first, without moving them from private to public coverage."

In the meantime, the White House can pursue the appropriate legislative changes in cooperation with Congress if it wishes to alter SCHIP.