When it comes to health care policy, the old and the young serve as the canaries in the coal mine, testing the political air for the rest of the population. If the new government isn't able to muster the guts--and the Congressional majorities--to improve access to health care for these vulnerable segments of the population, there isn't much hope for anyone else. On the other hand, if long-overdue changes to Medicare and the State Childrens Health Insurance Program (SCHIP) move forward swiftly, it could be a good omen for health care reform in general.
Some early signs give cause for cautious optimism: The new Congress has acted quickly on SCHIP, which gives states federal funds to help cover uninsured children who belong to relatively low-income families that nonetheless earn too much to qualify for Medicaid. Some 80 percent of Americans support legislation to expand funding and eligibility for SCHIP. In the past, such legislation has been twice passed by a bipartisan majority in Congress--and twice vetoed by George W. Bush.
Yesterday, the Senate succeeded in passing a bill increasing annual SCHIP funding by $32.8 billion, and expanding the program to cover 11 million children, rather than the current 7 million. The expansion will be paid for largely by a rise in the cigarette tax. The Senate earlier rejected two harsh amendments introduced by Republicans: one that would force some of the less impoverished families to contribute to plans costs "to stop the people moving from private plans
to a government-sponsored plan"; and one that would have limited states' ability to enroll documented immigrant children in the program. The Washington Post described the Senate debate as "rancorous"--but in the end, nine Republicans joined Democrats in voting for the bill.
Similar legislation had already passed in the House on January 14, and a final conference bill could be signed by President Obama as early as next week. Perhaps the most promising news is that the new SCHIP legislation is considerably better--more generous and more inclusive--than the two previous versions vetoed by Bush. A number of Republicans objected to this fact, accusing Democrats of double-crossing them on their earlier deals (as if that weren't what happened after every shift in party power).
SCHIP legislation has always enjoyed some bipartisan support. The same is not true of reforms to the Medicare Part D prescription drug benefit-Bush's signature piece of health care legislation, which is in effect a massive handout of taxpayer dollars to the insurance industry and Big Pharma. So what happens with Part D is perhaps a more useful predictor of things to come.