S-CHIP On Bush's Shoulder
With his vocal opposition to the expansion of the S-CHIP program to provide health care coverage for more of America's children, President Bush is returning to the same tried and true formula he first pioneered in Texas. That is, Bush initially fought the legislation on ideological grounds before caving to popular pressure and grudgingly accepting some version of the bill. Then, as with the Texas S-CHIP program, the Texas Patients Bill of Right and the 2003 Medicare prescription drug benefit, Bush claimed credit for it.
First, a little background. The 10 year-old State Children's Health Insurance Program is due to expire at the end of September. The program provides health care coverage to 6.6 million low income children whose families can neither afford private insurance nor qualify for Medicaid. The $5 billion annual federal contribution has been money well spent; as the CDC reported just three weeks ago, the percentage of uninsured children under age 18 dropped from 13.9% in 1997 to 9.3% in 2006.
Which is why the Senate wants to extend S-CHIP to cover 3.3 million more American children. Funded by a 61 cent per pack increase in the federal cigarette tax, a bi-partisan group of Senators led by Max Baucus (D-MT) , Chuck Grassley (R-IA) and Orrin Hatch (R-UT) want to double the President's proposed five year budget to $30 billion.
At least so far, President Bush is having none, promising to veto the bill on philosophical grounds. His argument is more philosophical than budgetary: expanding the proven S-CHIP plan would be the first step down the slippery slope to universal health care coverage. The Senate plan, Bush argues, "would cause people to drop their private insurance in order to be involved with a government insurance plan." On Wednesday, the President restated his belief in his moribund "consumer-based system" featuring health care tax deductions, health savings accounts and association health plans. (For more on why consumer-driven health care plans encourage employers to drop coverage while limiting access and boosting costs for their employees, see "Unhealthy Trends.")
As The New Republic noted, we've been here before. In the 1990's, then Texas Governor George W. Bush opposed a bi-partisan effort to expand S-CHIP in his state. Despite Texas' worst-in-the-nation status (then and now) in the percentage of residents without insurance, Bush (then as now) opposed the broadened program on both fiscal and philosophical grounds. As Salon reported in July 2000, Bush tried to limit eligibility to families with incomes at 133% of the poverty line, compared to the 200% standard adopted in most states (and over Bush's opposition, in Texas). Bush's hard line would have kept 200,000 kids off the program's rolls. As it was, the difficult and cumbersome application process limited sign-ups to only 28,000 of the 500,000 children eligible by mid-2000.
None of which stopped George W. Bush taking credit for the program during his 2000 presidential campaign. As Joshua Micah Marshall reported in Salon:
In Bush's press release it says: "When the CHIPs program was first implemented, Governor Bush embraced it as an opportunity to help deliver health coverage to thousands of uninsured children, and signed legislation providing health insurance for more than 423,000 children."
On July 20, 2000, Al Gore made a trip to San Antonio, Texas. Gore described Governor Bush's opposition to the program and the onerous eligibility process he set up to blunt participation by Texas families. "As a result," Gore said, "there are 600,000 children in Texas eligible for health insurance who don't have it." Sadly, Bush never paid a price for stonewalling on S-CHIP and his war against Texas' children.
By now, the Bush modus operandi on health care is all too familiar: oppose needed and popular health care programs but then claim ownership of them after they pass despite his efforts. For example, Governor Bush famously – and ferociously - opposed the Texas Patients Bill of Rights, enabling residents to sue their HMOs over denial of treatment. Afraid to veto the overwhelmingly popular bill, Bush cowardly allowed it to become law without his signature. That, of course, didn't stop him from claiming during the 2000 campaign, "As governor, I signed into law some of the toughest patient-protection laws in the nation."
More cynical still, Bush stated during the October 17, 2000 debate with Al Gore that he did not want any federal patient protection act to supersede the Texas law he falsely claimed to have signed.
"You know, I support a national patients' bill of rights, Mr. Vice President. I want all people covered. I don't want the law to supersede good laws like we've got in Texas."
Which, of course, is exactly what did. Bush not only signed legislation moving patients' lawsuits into much less friendly federal courts. In 2004, President Bush completed his flip-flop and had his Justice Department successfully argue for the supremacy of the national statute over state laws - like the one he never signed in Texas.
Bush's biggest health care flip-flop, though, came during the 2003 debate over adding a Medicare prescription drug benefit. As CBS reported in January 2003, President Bush initially opposed adding drug coverage to Medicare, noting "recent description of the proposal in government documents envisions 'no prescription drug coverage' for people in traditional fee-for-service Medicare." But facing overwhelming public support for the benefit and with his 2004 reelection looming, Bush did an about face. He supported and signed a bill creating a prescription benefit through Medicare and private insurers. (For more on the arm-twisting and fraud behind Bush's duplicitous Medicare RX plan, see "Medicare's Prescription for Failure").
Which brings us back to S-CHIP. Bush opposes it, but most Americans - and many Congressional Republicans, for that matter - support it. Sadly, one new factor suggests we might not see the usual Bush pattern of flip-flopping on health care issues. Finally, George W. Bush is not up for election.