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Children's health plan gets a dose of resistance

The Baltimore Sun

WASHINGTON -- The Bush administration says it will strenuously resist Democratic plans for a threefold expansion of the Children's Health Insurance Program, ensuring a clash with Congress over the most important health care legislation being considered this year.

Administration officials said that much of the new governmental coverage proposed by Democrats would simply replace private insurance, and they expressed concern about a sharp increase in the proportion of children covered by public programs in the past decade.

Dennis G. Smith, the federal official in charge of Medicaid and the Children's Health Insurance Program, said 45 percent of all children were covered by the two programs, up from 28 percent in 1998.

"The original intent of the Children's Health Insurance Program was to cover low-income children who were uninsured," Smith said in an interview. Democratic proposals to cover millions of additional children "would change the complexion of the program and take it away from its original intent," he said.

"At higher income levels," Smith said, "families are more likely to have private health insurance. If they become eligible for the Children's Health Insurance Program, you are more likely to be substituting public for private coverage. You could add billions of dollars to the program without insuring many new kids."

The administration says that 36 million children were enrolled in the programs last year - 29.4 million in Medicaid and 6.6 million in the Children's Health Insurance Program. More than 8 million children remain uninsured.

Democrats want to expand the children's health program as a first step to universal coverage, a goal endorsed by all the party's major candidates for president.

But Michael O. Leavitt, the secretary of health and human services, said the program "should not be the vehicle by which we insure every adult and every child in America."

The federal government has spent $25 billion on the children's health program in the past five years. President Bush wants to increase allotments to the states by $4.8 billion, providing a total of nearly $30 billion over the next five years.

Democrats want to triple spending on the program, by adding $50 billion, for a total of $75 billion over the next five years.

Rep. John D. Dingell, a Michigan Democrat who is leading House efforts to expand the program, said he was aware that Medicaid and the children's insurance program covered nearly half of all children.

"It's a great investment," Dingell said. "One of my problems with this administration is that there are people who know the cost of everything and the value of nothing."

If the White House resists Democratic plans for a major expansion of the popular program, Dingell said, "that's a ground on which I will be very happy to fight."

The Bush administration says it wants to "refocus the program on low-income uninsured children."

Bush has proposed reducing federal payments to the states for coverage of children with family incomes exceeding twice the poverty level. At least 17 states cover children above that level, and governors in several other states are trying to expand eligibility by raising the income limit.

In Maryland - one of the most generous states - Democratic Gov. Martin O'Malley wants to extend benefits to children in families that earn up to four times the federal poverty limit, or more than $80,000 a year for a family of four, as long as they pay a small premium.

Maryland has 106,000 enrolled in the plan, including 11,800 in families that earn between two and three times the poverty level, the group Bush is targeting, said Tricia Roddy, director of planning for Medicaid services in the state Department of Health and Mental Hygiene.

A family of four is considered poor if its annual income is less than $20,650. Dingell and Sen. Hillary Rodham Clinton, a New York Democrat, recently introduced bills that would encourage states to cover children up to four times the poverty level - up to $82,600 for a family of four.

While opposing any major expansion of the program, Bush has proposed a new tax deduction to help people buy private health insurance. In the past, he proposed tax credits.

Dingell scoffed at the idea. "To rely on a bunch of good-hearted insurance companies whose purpose is, quite frankly, to make money - to expect them to go into the charitable business of taking care of a lot of hungry and impoverished kids - strikes me as the height of folly," Dingell said.

Congress faces a deadline for action on the Children's Health Insurance Program. Legal authority for the program expires Sept. 30, and 14 states expect to run out of money before then.

The House and Senate have voted to provide about $750 million to help those states get through the next six months. But the money is included in a war spending bill that Bush has threatened to veto because it sets a timetable for gradually withdrawing most American troops from Iraq. So the future of the child health program is unclear.

Sun reporter David Nitkin contributed to this article.

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