Special Report

Digging Through SCHIP to Find Hillary’s Pony

Popular rejection of SCHIP expansion is making a return to Hillarycare unlikely.

By 12.4.07

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The advocates of government-run health care gleefully anticipate the upcoming presidential election. Convinced that Hillary Clinton will easily beat any candidate foolish enough to accept the Republican presidential nomination, they expect to see Hillarycare 2.0 enacted before they fully recover from their inaugural party hangovers.

This sense of complacency has been bolstered by the recent battle between Congress and the White House over expansion of the State Children's Health Insurance Program (SCHIP). Ezra Klein's assessment of its effect on the socialized medicine "coalition" echoes that of Jonathan Cohn and other "progressive" policy wonks: "...its galvanization of liberal interest groups and creation of new, pro-expansion coalitions is creating the template for what the Clintons didn't have: An aggressive, sophisticated, well-funded, pro-reform lobby." Presumably, this lobby will be the force that finally leads us to the promised land of Hillarycare.

But Klein, Cohn and others of their persuasion are indulging in wishful thinking. Recent developments both within the Beltway and on the West Coast bode ill for the larger cause of "universal" government-run health care. Not only have congressional Democrats been unable to prevail against the minority party and a lame duck president in their effort to expand SCHIP coverage to middle class kids and adults, a similar proposal has just been overwhelmingly rejected by the voters of the deep blue state of Oregon.

As to the congressional SCHIP debate, one has to do a lot of digging to find a pony for the pro-Hillarycare crowd. Having already vetoed one SCHIP bill, President Bush says he will continue to reject child health care legislation that significantly exceeds the $5 billion increase he has proposed for SCHIP. And, even after a media blitz that included the disgraceful exploitation of Graeme Frost, the "aggressive, sophisticated, well-funded" health care coalition was unable to cobble together a veto-proof majority that would support the $35 billion increase the Democrats initially demanded.

In fact, the pro-expansion coalition actually lost ground as negotiations proceeded on a compromise bill. Believing that public opinion was on their side, the Democrats and their allies clearly felt that a few token concessions would enable them to pick up enough GOP votes for an override. But on November 15, a group of rank-and-file Republicans proposed changes to the bill that would have imposed eligibility limits on Medicaid. This proposal, which stalled negotiations and assured the eventual shelving of the SCHIP expansion bill, signaled that the tide had turned. The Democrats found themselves under increasing pressure from the states to wrap things up before the money ran out in December, while the Republicans were feeling little urgency to get a SCHIP deal done.

This lack of urgency was probably the result of recent events in Oregon. Like their soul mates on Capitol Hill, Oregon's Democratic Governor, Ted Kulongoski, and his accomplices in the state legislature wanted to expand eligibility for its SCHIP program (called "Healthy Kids") to families whose incomes far exceed the poverty level. Indeed, although it included the half-hearted stipulation that children from high-income families would not receive the usual government subsidies, their proposal would have extended SCHIP coverage to all of Oregon's kids and many of their parents.

Such a dramatic increase in the scope of "Healthy Kids" promised to be very expensive, of course. But Governor Kulongoski and his allies, further emulating their Beltway brethren, thought they had the answer to that problem in their proposal to fund the expansion with an 84-cent increase in the state cigarette tax. They expected Oregon voters to approve this scheme via Measure 50, a referendum they promoted with a series of video ads featuring Dickensian images of sickly waifs. Unfortunately for Governor Kulongoski and his fellow Democrats, Oregonians had other ideas, and on November 6 rejected the measure 60%-40%.

It is probably no coincidence that Congressional Republicans discovered their backbones immediately following the defeat of Measure 50. The Oregon debacle revealed the fatal flaw in the Democratic SCHIP strategy: an inordinately low opinion of the public's intelligence. Democrats inside the Beltway and in Oregon obviously assumed that incessant references to sickly children, fiendish Tobacco companies, and mean-spirited Republicans would garner enough public support to get them over the top. But the voters aren't buying the hype.

The skeptical attitude of Oregonians is consistent with broad public sentiment, as measured by a recent Gallup poll showing that a majority of Americans are not in favor of extending SCHIP coverage to the middle class. According to the survey, 52% of Americans agree with President Bush that most of the program's benefits should be reserved for children in families earning less than 200% of the federal poverty level. The poll also shows that most of the public shares Bush's concern that SCHIP expansion is a step toward socialized medicine. Judging by their newfound courage on the issue, Congressional Republicans are hearing a similar message from their constituents.

None of this is good news for those optimistic Hillarycare enthusiasts. Things will never be easier for Klein's "pro-reform lobby" than they were at the beginning of the SCHIP reauthorization debate. The combination of a sympathetic cause -- children's health care -- and an unsympathetic funding source -- smokers -- constituted a far more powerful rhetorical weapon than anything they will be able to deploy on behalf of generic health care reform. Yet it hasn't been enough. An aggressive -- not to say shameless -- PR campaign on behalf of SCHIP expansion hasn't convinced Congress, Oregon's voters, or the general public.

What, then, are Mrs. Clinton's chances of pulling off a comprehensive renovation of American health care? Sadly for the people who have spent the last thirteen years patiently awaiting the second coming of Hillarycare, the answer to that question is "zero."

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About the Author

David Catron is a health care revenue cycle expert who has spent more than twenty years working for and consulting with hospitals and medical practices. He has an MBA from the University of Georgia and blogs at Health Care BS.