COVER, VETO, DEAL

Congress is likely to emerge with two leading proposals to reauthorize and expand the popular and needed State Children Health Insurance Program. President Bush has promised to veto both, leaving Congress with a strong incentive to pass the stronger of the two, knowing that negotiations with the White House will follow.

SCHIP began in 1997, when millions of children were not getting the kind of early, affordable care they needed to thrive in school. SCHIP began with $40 billion and, largely, has been effective. It provides coverage to about 6 million children, sharply reducing the number of uninsured children (even as the program has also caused some families to shift their coverage from private to public pay) while the total number of those uninsured in America has risen.

Children covered by SCHIP are more likely to get regular health care – and not in emergency rooms, either – and better preventative care. About 4,500 Maine children receive SCHIP coverage, although more qualify for it.

A Senate reauthorization plan for SCHIP would add $35 billion over five years to the program, bringing the funding to $60 billion and using tobacco taxes to pay for the expansion. A more ambitious House version would add $50 billion and would help cover the additional costs by paying private Medicare plans the same amount of the traditional public plans. The current SCHIP authorization ends in September.

Maine’s congressional delegation has been very supportive of expanded SCHIP funding, and Sen. Olympia Snowe and Rep. Tom Allen, who are on the committees relevant to its reauthorization, have been out front in proposing substantial expansions for coverage. They have strong incentive: About 9 million Americans under age 19 remain uncovered.

President Bush says he will support a $5 billion expansion, seeing the kind of growth proposed by Congress as leading the nation “down the path to government-run health care for every American.” SCHIP is a funding mechanism for health care, not the care itself, and for 45 million uninsured Americans, including children, the nation currently has an apathy-run system that costs everyone in obvious and subtle ways – the price of a car, the ability to change jobs, the number of minutes a doctor sees a patient are all affected by the current system.

The president is right, however, that a substantially expanded SCHIP means more government involvement. That is the price these days for providing more coverage for children in the absence of a comprehensive reform of a health-care system that costs too much, providing an abundance of care for the insured even when that care doesn’t lead to improved health, and excludes too many people.

Having tipped his hand on the veto threat, Congress has nothing to lose by passing the largest expansion it can pay for, and then being prepared to compromise with the president. It’s not a great way to fund a program but given the limited time before the program ends, it may be the best Congress can do.