Sarah Solon

It’s not just about federal inaction. It’s about standing in the States’ way.

The papers this week and last have reported back-to-back pledges from Governors in New York and California to dramatically extend health insurance. In New York, we heard from Governor Spitzer about his plans to cover all children. And yesterday, Governor Schwarzenegger unveiled a plan to extend health care coverage to all of California's 36 million residents.

It's clear that states are stepping in with their own plans aimed at rectifying the federal inaction that has left 47 million Americans uninsured. What's even more troubling than this federal failure to cover the uninsured, however, is the ways in which government on the national level is actively eating away at American's access to health insurance. From the federal government, it's not just a failure to cover, it's an exercise in whittling away at access to coverage.

Take this prime example. Governor Spitzer's plan to insure all children in New York is great - carrying the possibility to be one of the best policy improvements in the state this year. But just take a minute and guess the source of its major opposition. From last week's New York Times: "The biggest obstacle, they said, could be new federal requirements that people signing up for Medicaid produce birth certificates or other proof of citizenship."

And just what are these new federal requirements? Without a doubt one of the Worst Policies of 2006. From the section in our Year in Review titled "Blaming Babies":

Approximately four million babies are born in the United States each year. The cost of one-third of these deliveries is covered by Medicaid because the mothers are low-income and uninsured. Up until this July, any baby born to a mother whose delivery was paid for by Medicaid was automatically covered under the program for a year. Not any more. The Bush administration announced that parents must now file an application and present proof of citizenship for coverage of their children to kick in. Their reason? A controversial interpretation of the Deficit Reduction Act. Doctors and immigrant activists have protested, arguing that this policy is legally unnecessary, that too many infants will go without coverage in the weeks while birth certificates and Medicaid applications are being processed, and that some families won't file the applications out of fear of deportation. Opponents of the policy claim it is driven more by anti-immigrant sentiment than sound fiscal or health care policy. California has flat out objected, saying that any baby born in the U.S. is a citizen and should not need to prove it. That's enough proof to add it to our "Worst of" list.

And on the topic of these new federal guidelines, it's important to highlight one of the most interesting aspects of California's proposed plan:

Under Mr. Schwarzenegger's proposal, Medi-Cal would be extended to adults who earn as much as 100 percent above the federal poverty line and to children, regardless of their immigration status, living in homes where the family income is as much as 300 percent above that line, about $60,000 a year for a family of four. Medi-Cal is currently limited to adults with children, and children with documented residency are covered if their family's income is up to 250 percent above of the poverty line.

What I hope is that this plan from Schwarzenegger will cut into the federal regulations requiring proof of citizenship from infants before extending health care coverage, and make sure that all children really do get the coverage they are promised under his suggested plan. In New York, Spitzer still has until the end of the month to say explicitly how he plans to enact this plan, and I hope he will include the same sorts of protections to mitigate the harmful effects of the new federal regulations on infant health insurance during the vulnerable first months of their lives.

And while we're on the topic on California's new plan, I offer you a couple quick hits from the Progressive States network's excellent analysis of the individual mandate, which defined Massachusetts's' health care policy in 2006 and which is present in California's plan for 2007.

The first comes from our Year in Review:

MASSACHUSETTS AIN'T THE ONLY PLAN IN TOWN

It's become blatantly clear that, with 47 million Americans uninsured, America has a health care coverage crisis. Fed up with federal inaction, states have started expanding coverage on their own terms.

While Massachusetts' health plan got the media splash, Vermont enacted a far better plan in 2006 with clearer standards for health care affordability and without the problematic "individual mandate" - the cornerstone of the Massachusetts plan - that requires struggling middle-class families to purchase health insurance without addressing its skyrocketing costs.

In contrast, Vermont's 70,000 uninsured will have the option to purchase "Catamount Health," a comprehensive insurance package offered by health insurers. Premiums are subsidized on a sliding scale for families who earn less than 300% of the federal poverty level ($60,000 for a family of four). Vermont will also offer a program to help workers afford employer-based coverage.

The program is paid for through a combination of cigarette and tobacco tax increases, a $365-per-employee annual assessment on employers that do not provide private coverage, and Medicaid funds. To improve health and reduce costs, Vermont is doing things like developing a new chronic care management program.

As a voluntary system, Vermont's plan does not ensure universal coverage. But it promises to make a significant dent in the size of the State’s uninsured population.

And the second from their excellent policy briefing:

[In the California plan,] an employer mandate requiring coverage or a minimum contribution of 4% of payroll to the state. The employer mandate applies to all businesses with 10 or more employees, will help prevent irresponsible employers from dropping coverage, and provide funding for health insurance so that taxpayers don't end up picking up the tab for these irresponsible employers. The payroll assessment is more far-reaching the flat $295 per year assessment in the recently adopted Massachusetts plan. In comparison, an uncovered employee earning $40,000 per year in California would result in an employer assessment of $1,600 under Schwarzenegger's plan. "A serious concern is what the minimum package required by the state will be to avoid the assessment is a critical variable. Merely requiring high-deductible coverage will do little to improve health outcomes." - Nathan Newman, Policy Director, Progressive States Network

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Posted at 10:22 AM, Jan 09, 2007 in Health Care
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