At the time of the veto, President Bush's press secretary, Dana Perino, said "Congress's bill goes far beyond Schip's mandate by covering some higher-income households and adults.''
A recent Yahoo! news article explained,
"Schip, which now covers about 6 million children, was created to help families with incomes too high for Medicaid, the U.S. insurance program for the poor, and too low to afford private coverage. Over the years, some states have boosted income eligibility, reaching a high of $72,000 for a family of four in New Jersey, the most generous state.What I haven't heard is someone asking and answering the obvious question. Why would a family with an income of $72,000 and only 2 kids need to apply for supplemental insurance? It is intellectually dishonest to attempt to evaluate this legislation without answering this question.
The measure offered today would permit states to continue enrolling kids from families with incomes up to $62,000 for a family of four, or 300 percent of the U.S. poverty level."
As a "professional" (what better way to express my 7 1/2 years - and counting - use of pediatric health care) consumer of health care and user of both private and state resources to pay for it, I can give you three answers to this question, right off the top of my head.
First, private medical insurance doesn't cover nearly what it used to. Copays are higher, co-insurance is higher, maximum out-of-pocket amounts are higher or non-existent, and lifetime maximums are more and more common. What this means is that even when you have private insurance, you still have to pay a significant amount out of your own pocket. If you reach your lifetime maximum, which is very easy with a life-threatening illness such as cancer or a traumatic injury, you're out of luck. All expenses from that point on are your own responsibility.
A family can reach their lifetime maximum (the most an insurance company will pay out for a given individual in their lifetime) in an extremely short time in the case of illnesses like cancer or conditions requiring multiple surgeries. And you can bet that a person who reached their lifetime max would NOT be able to find any private insurance company willing to insure them for any amount of money. And you can also guarantee that their medical bills will continue -- conditions don't magically resolve when the insurance runs out!
Regardless of whether you meet your annual out-of-pocket max (the most you should have to pay of your own money for copays and coinsurance in a calendar year), you still have to pay your prescription copays. Our prescriptions copays last year totaled $1,000. This year will be higher as Elli was much sicker and Luke was born with his own medical issues. And we have a really good insurance plan!
Second, private medical insurance does not cover "educational" expenses and frequently denies claims for medical equipment considered "preventative" -- needed to prevent complications down the road. For example, many types of speech therapy are considered educational rather than medical and are not covered. We've had to appeal for standers and walkers to get our daughter bearing weight while standing. She needs to do this to increase her bone density and decrease osteoporosis, injuries, and the need for surgery when she's older. Even when private insurance does cover these items, the copays are significant.
Third, medically-complicated patients bring with them many hidden costs that are not covered by medical insurance. Some of these hidden costs include modifications to the patient's home (e.g. wider hallways, ramps, accessible bathrooms), diapers and wipes (imagine instead of getting rid of your diaper bill, it goes up as diaper size increases and the number in a package decreases), vehicle adaptations, childcare/respite care (because you can't find just anyone to watch a medically-complex patient and you have to take breaks), home care nursing or personal aides (a single adult may be physically unable to safely transfer larger children and adults from bed to wheelchair to exam table to stander), and special diet needs (e.g. formulas, thickeners, feeding equipment).
So, even if you are that family in New Jersey with two children and an income of $72,000 a year, you could very easily find yourself in financial ruin if someone in the family receives a catastrophic injury or diagnosis. I know many families personally who have just resolved themselves to the reality that they will never pay off their medical bills. They are forever in debt to the hospital with medical bills totaling over $1 million dollars and no end in sight.
We have been very fortunate. One of us is employed by a large, self-insured company that has, for the most part, covered the bulk of the children's medical bills. Our out-of-pocket costs have increased significantly in the last 7 years, but as long as we stay within our network, we have been able to manage it with some careful planning. (We had a scare earlier this year when our insurance and our local children's hospital didn't come to a financial agreement until the last day of their contract. If the hospital had suddenly become an out-of-network hospital, our out-of-pocket costs would have quadrupled.)
We've had to look to state programs, funding in part by the Schip, for help with many other expenses, including those listed above. Qualifying for that assistance is rigorous, requiring documentation of diagnoses, income, resources, etc. And the process for gaining approval for and payment of an item through these programs is frustratingly long and full of red tape. So the states are not just handing out money indiscriminately!
The Schip program is one of the truly legitimate uses of our tax dollars, I believe. It's one way that we can help take care of those struggling with life-shattering events and illnesses. The money goes to states to create programs that fit their populations. Our state desperately needs additional funding for its programs, and I'm sure we're not alone.
It would be nice to see our government spend some money to take care of its bread-and-butter citizens -- the ones who work hard, pay their taxes, try their best to raise responsible children, but are struggling with tragic circumstances-- for a change.
