1. Maryland: To Win CHIP Battle, Enlist Employers "We want to help kids more than you do." That's what the Democrats have been saying in the battle for children's health insurance this fall, and it's not working. So it's time for them to try a new strategy and stress the real advantage of the State Children's Health Insurance Program: It favors working parents and the businesses that employ them. CHIP targets the group of people most likely to be uninsured: families that earn too much to qualify for Medicaid but can't get health care through their jobs. It's up for reauthorization this year, and the real battle is over which families will be eligible. Democrats want to allow states to offer CHIP to families higher up the income scale, while Republicans want to limit it to the neediest children. President Bush vetoed one version of the bill, and a new version passed the House last month without a veto-proof majority. Democrats have employed a blunt political strategy: Repeatedly accuse your opponents of hurting children, and hope the public catches on. But the public overwhelmingly supports expanding the program, and this has done little to change the minds of enough Republican lawmakers. And the argument that anyone wants to hurt children smacks of political manipulation. But there is another strategy available. The fact that CHIP targets kids with working parents means there is another important--and, so far, ignored--group of program beneficiaries: employers. As health care costs skyrocket, employers (particularly small ones) are increasingly hard-pressed to provide insurance for their workers, let alone workers' dependents. Yet employees with health insurance--and employees whose kids have health insurance--are more productive and reliable than those without, regardless of who is paying the premiums. In other words, CHIP takes the burden off the low-wage employers who find it difficult or even impossible to provide health insurance themselves. And it's not just health care. A whole network of anti-poverty programs set up to benefit low-wage workers and their families, including food stamps, child care subsidies and the earned income tax credit, contributes to the stability and productivity of the labor force. All of this comes at very little cost to employers, who might even come out ahead if government programs substitute for private wages and benefits. Why should Democrats care? Because employers are political pragmatists who have the power to help sustain the programs they like. What policy scholars know is that social programs that spread the benefits across large, politically diverse, powerful segments of the population are less vulnerable than programs that target narrow groups of the poor. This is why an anti-poverty system that benefits workers and their employers would be likely to withstand budget crises and political battles like the present one. This is particularly true in a system where employers provide crucial political support for Republicans. But employers will only support government programs if they understand how those programs affect them. Right now, very few do. Through conversations with business owners and their lobbying groups across the country, I have heard over and over that employers don't see the relevance of CHIP to their bottom lines. Democrats, who have spent so much time in recent years demonizing Wal*Mart and much of the rest of corporate America, are partly to blame. By drawing positive attention to the connection between CHIP and employer labor costs, Democrats could bring historically conservative business leaders to the table in support of exactly the thing progressives want: the freedom for states to set high eligibility levels if they choose. A partnership between low-income workers and low-wage employers would be revolutionary--and no doubt highly unsettling--in our polarized, class-based political system. But in failing to consider business as a potential ally, Democrats are threatening the future of the programs they hold most dear. [Nicole Kazee, Baltimore Sun, 11/09/07] 2. North Dakota: Middle Class Are Doing Their PartMost people recognize there are problems with health insurance coverage. Costs are certainly rising faster than most people's hard-earned income. A family plan usually costs between $7,000 to $10,000 a year. Working families are taking on more of the burden. Obviously, these trends are not sustainable. You'd expect elected officials to try to help. Right now, there's a "goal line" debate on children's health care. Congress passed a compromise extension of the State Children's Health Insurance Program. This covers children in families making too much to qualify for Medicaid, but who still can't afford health insurance. The bill increases funding from enough to cover 6.6 million children to covering 10 million children in working families. But President Bush vetoed the bill. Congress addressed opponents' major concerns, but Bush vowed he'll veto it again. Opponents say parents should buy their own health insurance. Where do $7,000 to $10,000 premiums fit into most family's budgets? In North Dakota, legislators set maximum eligibility for CHIP at a family net income of $28,920. Over that, they're on their own. If the feds pass a new bill, North Dakota's CHIP will cover kids in families with up to $30,986 net income. One of the legislators behind North Dakota's CHIP law is Sen. Judy Lee (R-West Fargo). But, now, she is vocally supporting the president's veto and was upset this bill could mean health care to kids in hardworking middle-class American families. Many opponents, including Lee, incorrectly lead people to believe the bill would allow children in high-income families to qualify for CHIP. In fact, the first bill the president vetoed said nothing about income eligibility. States develop much of their own CHIP to fit local circumstances with approval by the Bush administration. Some states like Connecticut have set qualifying income at $61,974, which is 300 percent of the poverty level for a family of four. The cost of living, especially housing, is definitely higher in Connecticut than it is in Bismarck. What kind of leadership doesn't see that hardworking middle-class families are doing their part? It is time to come together and build this in a better way. Passing CHIP is an important step forward. [Don Morrison, The Bismarck Tribune, 11/23/07] 3. California: Bitter Battle Over Children's Health Care Starts to Hit Enrollment President Bush and Congress have spent much of autumn locked in a bitter fight over expanding a popular children's health insurance program, and neither side has been willing to blink. But for states such as California, the effects of the stalemate are hitting home. Unless there's an infusion of cash--and quickly--California will run out of federal money to pay for its program in June. To prepare for the shortfall, state officials will decide in the next two weeks whether to stop enrolling new children and send letters to 56,600 families telling them their children will lose health coverage on December 31. "These are horrible options," said Lesley Cummings, who manages the state's Healthy Families insurance program for low-income kids. "We never thought we were going to be in this place." California isn't alone. The Congressional Research Service estimates that 21 states will exhaust their federal money next year--nine will run out of money in March--if Congress simply keeps the program funded at the current levels. Congress approved a short-term extension until Dec. 14 for the program, which is run by the states and paid for with state and federal money. But while lawmakers and the White House have been negotiating for weeks over a compromise to boost funding, no deal has been reached. Without a stable source of money for the year, the states say they must start planning now to freeze enrollment in their programs and possibly drop coverage for thousands of children. "Our situation is dire," said Suzanne Esterman, spokeswoman for the New Jersey Department of Human Services, which has 195,000 children and adults in its program and is expected to run out of money in March. "We're looking at all our options...although we're hopeful and we're working with our congressional delegation." Georgia's program is already running a deficit, and is surviving only with a temporary grant from the Department of Health and Human Services. Health care providers are asking if they should cancel appointments for kids enrolled in the program, and parents are asking if they should keep paying their premiums. The state is pulling the medical records of kids to determine who are the sickest, so if they have to drop children from the program they'll start with healthier children. "Georgia is on the edge of the cliff," said Dr. Rhonda Medows, commissioner of the Georgia Department of Community Health. "We don't want to think about kids having cancer, but how do you schedule someone for six weeks of chemotherapy if they only have four weeks left in the program? Does the oncologist start the therapy or do they wait? How do you plan? You can't." The State Children's Health Insurance Program--known by its acronym, CHIP--has had bipartisan support since it was passed in 1997 by a Republican Congress and signed into law by Democratic President Bill Clinton. It was designed to cover children whose families made too much to qualify for Medicaid--the federal health care program for the poor--but couldn't afford private insurance. But the effort to expand the program is now mired in partisan politics. The Democratic-led Congress has twice passed a bill to expand the program to cover 10 million children, a $35 billion increase over five years paid for by a 61-cent-per-pack increase in the cigarette tax. Bush vetoed the bill in October, calling it too costly and not narrowly targeted enough on poor children. Many Republicans support the bill and it passed the Senate with a veto-proof majority of more than two-thirds. But in the House, the bill fell 10 votes short of the two-thirds needed to override Bush's veto. California is among the states hardest hit by the impasse because of the sheer size of its programs. CHIP funding helps cover more than 1 million in the state: 835,000 children enrolled in Healthy Families, 8,000 pregnant women and 250,000 kids who are enrolled in Medi-Cal. The state also has recently expanded enrollment using federal money it saved from past years. State officials say they need $1.2 billion for the 2008 fiscal year, which started October 1, to keep pace with the current enrollment projections. But if Congress passes flat funding--as it did in the temporary extension--California would be at least $265 million short. State officials could ignore the warning signs--what Cummings calls the "trust in the goodness of the universe" option--and make no changes to enrollment. But if Congress and the White House don't approve more money, the state would have to shut down the program in June and every child would lose coverage. A more proactive approach would be to freeze enrollment and start dropping a smaller group of kids now, Cummings said. The state would have to kick out an average of 66,000 children each month to keep the program solvent. By September, if the cuts continued, nearly 600,000 kids--70 percent of enrollees--would have lost their insurance. The state's Managed Risk Medical Insurance Board, which oversees the Healthy Families program, approved emergency regulations earlier this month to give it the power to create waiting lists or drop kids. The board plans to meet December 5 to decide which options to choose. If the board approves the latter option, the agency would start sending letters December 6 alerting families that their children will lose their coverage at the end of the month. In San Francisco, an average of 1,000 kids a month will lose their insurance if the state is forced to make the cuts. It would be a major setback to the city's effort to provide universal health coverage for all children. "Even one month without coverage can be catastrophic, either physically for the children or financially for those low- and moderate-income families," said Jean Fraser, chief executive officer of the San Francisco Health Plan, the city-sponsored HMO that covers lower-income residents. Anthony Wright, executive director of Health Access California, which advocates for affordable health care, said the cuts threaten to undermine 10 years of state outreach efforts to get low-income kids insured. "Even if the cavalry comes to the rescue later, it creates all sorts of issues for these families," Wright said. "Can you easily find them again after the money comes back online?...It's hard to get their trust back." State officials are putting heat on the White House and Congress to act now. Cummings has pleaded with California's delegation to support increased funding for the program. All 34 of the state's House Democrats voted for the bill expanding the children's health program, while Rep. Mary Bono, R-Palm Springs, was the only one of 19 California Republicans to back it. Both of the state's Democratic U.S. senators support it. "Both sides seem to feel that it's the other side that's holding up progress," Cummings said. House Speaker Nancy Pelosi, D-San Francisco, has refused to budge from her insistence that the program be expanded to cover 10 million children. Democrats have played the issue for maximum political advantage, with a recent CBS News poll showing that 81 percent of Americans support expanding the program. "The speaker fully understands the concerns of states like California, and that is why we are continuing to work to overcome the president's veto and the obstructionism of a small number of Republicans," said her spokesman, Nadeam Elshami. Elshami added that "should it become necessary, steps will be taken to ensure that states are not forced to take drastic measures to cut enrollment and coverage." The White House also is holding firm, refusing to back a bill unless it narrows eligibility to only lower-income kids. "We are still open to negotiating and compromising with Congress, but they don't seem to be in the negotiating mood," White House press secretary Dana Perino said last week. Georgia's Medows has some advice for Washington policymakers: Stop fighting over the program and start funding it. "They need to resolve this today--not next month, not next year, not after election day," she said. "While they are debating expanding CHIP, children who are already enrolled or eligible are suffering because this piecemeal appropriation is disrupting services. They need to fund it appropriately." [Zachary Coile, San Francisco Chronicle, 11/25/07]