DEFICIT SPENDING didn't bother the Bush administration when the issue was tax cuts. Congress had no trouble finding "savings" to supposedly offset new costs when the costs were in a corporate tax bill stuffed with special-interest provisions. But when it comes to health care for poor children, different, stricter rules seem to apply. This week's lame-duck Congress is poised to leave town without taking any action to restore $1 billion in federal funding for children's health care that wasn't used before its Sept. 30 expiration and therefore reverted to the Treasury. Republican lawmakers say they don't oppose renewing the funding but insist that it has to be paid for with cuts elsewhere. The result is that some 200,000 low-income children will be at risk of losing health coverage in the next three years.
The issue involves the State Children's Health Insurance Program (SCHIP), which was launched in 1997 to help states provide coverage to low-income children whose families earn too much to be eligible for Medicaid. With $40 billion in federal matching funds over 10 years, this was the largest expansion of health coverage for children since the adoption of Medicaid in the 1960s; last year alone the program enrolled 5.8 million children. Even as the share of Americans without health insurance is growing, the percentage of children lacking coverage has stayed stable, in large part thanks to Medicaid and SCHIP.
But under SCHIP's complicated use-it-or-lose-it formula, unspent money is going back to the Treasury just as some states are starting to run out of money -- money they need not to expand coverage but to keep serving the children who already have it. Between now and 2007, 18 states (including Maryland) are projected to have insufficient federal funding, which would require them to drop some children or find money elsewhere.
"America's children must have a healthy start in life," President Bush declared in accepting the Republican nomination in September. "In a new term, we will lead an aggressive effort to enroll millions of poor children who are eligible but not signed up for the government's health insurance programs. We will not allow a lack of attention, or information, to stand between these children and the health care they need." Stirring rhetoric, but what's the point of providing information and then failing to provide money? It's a dubious sort of fiscal responsibility that only kicks in when poor children's health is at stake.