That SCHIP Won’t Sail

{Crossposted at To Us!.  Permission to use noncommercially with attribution.}

While Congress was away, Bush continued to do his sneaky freaky Friday attack on S-CHIP.  Much of this post is simply a replay of events that occurred prior to Congress’ return last week. But one thing Bush forgot in his unrelenting quest to punish the poor, the sick, the elderly and the vulnerable: the senators are facing those people at the polls, and they aren’t looking too good when it comes to cutting off people at the knees.

So the senators are mutinying against Bush’s bowl of strawberries re-enactment. The only think lacking is the presidential candidate with enough spine to act as a realistic Mister Roberts. A cross between the mutiny on the Bounty and Mister Roberts, the governors are finding themselves smack dab in the middle of where policy meets constituent suffering.

On Friday August 17th in the usual news dump, timed to garner the least amount of traditional media attention, the Bush White House orchestrated two attacks on healthcare: CMS announced that it will no longer reimburse for healthcare services provided as a result of some types of what it deems preventable medical errors, and Bush announced that he is severely crippling the SCHIP program. Scarecrow, at FireDogLake, analyzes this from a sociopolitical standpoint that makes one’s straw spontaneously combust.

In addition, just prior to the Senate’s August recess, Jim DeMint (R-SC) put a hold on the SB 558 Mental Health Parity bill.

Robert Pear of the NY Times has been providing excellent descriptions and analyses of the seemingly disparate news items. In the SCHIP Friday night stealth attack, states would be held to an unrealistic standard of covering eligible children at a 95% rate.

The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.

Administration officials outlined the new standards in a letter sent to state health officials on Friday evening, in the middle of a monthlong Congressional recess. In interviews, they said the changes were intended to return the Children’s Health Insurance Program to its original focus on low-income children and to make sure the program did not become a substitute for private health coverage.

After learning of the new policy, some state officials said yesterday that it could cripple their efforts to cover more children and would impose standards that could not be met.

“We are horrified at the new federal policy,” said Ann Clemency Kohler, deputy commissioner of human services in New Jersey. “It will cause havoc with our program and could jeopardize coverage for thousands of children.”

Stan Rosenstein, the Medicaid director in California, said the new policy was “highly restrictive, much more restrictive than what we want to do.”

The poverty level for a family of four is set by the federal government at $20,650 in annual income.

As with issues like immigration, the White House is taking action on its own to advance policies that have not been embraced by Congress.

In his budget in February, President Bush proposed strict limits on family income for the child health program. Both houses of Congress voted this month to renew the program for five years, but neither chamber accepted that proposal. Legal authority for the program expires on Sept. 30.

The administration’s new policy is explained in a letter that was sent about 7:30 p.m. on Friday to state health officials from Dennis G. Smith, the director of the federal Center for Medicaid and State Operations. The policy would continue indefinitely, though Democrats in Congress could try to override it.

–snip–

In his letter, Mr. Smith set a high standard for states that want to raise eligibility for the child health program above 250 percent of the poverty level.

Before making such a change, Mr. Smith wrote, states must demonstrate that they have “enrolled at least 95 percent of children in the state below 200 percent of the federal poverty level” who are eligible for either Medicaid or the child health program.

Deborah S. Bachrach, a deputy commissioner in the New York State Health Department, said, “No state in the nation has a participation rate of 95 percent.”

And Cindy Mann, a research professor at the Health Policy Institute of Georgetown University, said, “No state would ever achieve that level of participation under the president’s budget proposals.”

In the Medicare Friday news, Pear reports about the policy change, and also a little-noticed, but important fact: healthcare insurers are waiting with bared fangs, ready to rip into hospital and physician reimbursement with more claims denials. Patients are at risk of being denied care when they are deemed too high risk to incur an infection, illness or injury as a result of a designated “preventable medical error” such as a bedsore or a venous access infection.  Hospitals, physicians and insurers will be in direct adversarial positions to patients, who are going to be blamed for preventable errors at every opportunity.

The other risk is that when hospitals are denied reimbursement, they will respond by decreasing direct care staff – and usually the highest earners in this category are registered nurses, and hence, they are the most vulnerable to downsizing.  This starts another cycle of poorer patient care and leads to yet more complications and preventable errors.  And so the vicious cycle spins with more patients caught in its vortex.

In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.

–snip–

Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.

Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”

Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

Susan M. Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group, said, “Private insurers will take a close look at what Medicare is doing, with an eye to adopting similar policies.”

In early August, just before the Senate recessed, Jim DeMint put a hold on SB 558, the Mental Health Parity bill. The Congressional Quarterly via the Kaiser Network  reported:

A hold placed by Sen. Jim DeMint (R-S.C.) has delayed until after the August recess Senate consideration of a bill (S 558) that would mandate mental health parity, CQ Today reports. The measure, sponsored by Sen. Pete Domenici (R-N.M.), was on track to be passed by voice vote before the August recess after insurers, businesses and mental health advocates had reached a compromise. However, DeMint and Sen. Tom Coburn (R-Okla.) placed holds on the legislation. Coburn’s hold was dropped after his concerns were addressed, but DeMint maintained his hold, saying that the bill should be discussed on the floor before approval, according to CQ Today. “Sen. DeMint isn’t holding this bill, he is simply objecting to passing it without a chance for debate or amendments,” DeMint spokesperson Wesley Denton said, adding, “[T]his is a very large and costly mandate that could price a lot of Americans out of health insurance, and it needs to be considered carefully” (Armstrong/Wayne, CQ Today, 8/7).

What links these three seemingly disparate actions by Bush and the Republicans?

 
• All three were done when Congress was caught unawares.

 

• All were done under tight time frames and little time for Congress to respond and take defensive action.

 

• All were taken against populations that either can’t vote (children) or that are more likely to be unable to vote (those with untreated or under-treated mental illness and those who suffer life-altering complications as a result of the types of “preventable medical errors” listed in the Medicare reimbursement proposal).

 

• All are direct attacks on providing essential healthcare to the most vulnerable segments of the US population.

 

• All are aimed at attacking single payer insurance

 

• All are aimed at providing more sources of profit for private healthcare insurers.

 

• All are aimed at undermining government agencies’ efficacy and efficiency.

A couple of other related facts:

There are 1.8 million veterans who have no health insurance whatsoever, and of whom the majority suffer from untreated or under-treated mental illness and chronic physical illness. The Army has been issuing chapter 5-13 discharges in order to get out of providing needed mental healthcare to returning Iraq and Afghanistan soldiers and marines. With the gross disparity in mental health benefits being shockingly restricted or nonexistent, and the almost 50% rate of soldiers incurring symptoms of acute mental illness, how are these denials of care, parity and reimbursement going to “support our troops”?

When children don’t receive vaccines, preventive dental and healthcare, and subsequently transmit communicable diseases in their communities, how are all Americans assured of adequate and safe public health?

When patients who are at high risk to fall, have compromised immune systems leaving them vulnerable to infections, or are confused and wander denied hospital admission and physician care due to the perceived risk that the providers may not be reimbursed for care, what happens to them?

Americans’ public health is not secure.  Bush is not protecting America.  He’s doing just the opposite; he’s making Americans much, much more vulnerable to becoming victim to communicable diseases, to suffering needlessly because of a lack of accessible and affordable essential healthcare, and of causing those preventable deaths and complications – the very things he won’t allow Medicare to pay for.

What can you do?

 
• Write to your Senators and to your Representatives.

 

• Politely demand that the hold on SB 558 – the Mental Health Parity Bill – be lifted and the bill passed.

 

• Demand that the promised Bush veto of the S-CHIP Reauthorization bill be overridden in order to protect more children.

 

• Demand that the Senate take action to prohibit Bush from restricting eligibility of children for SCHIP.

 

• Explain how denying children essential healthcare puts the nation’s public health at risk.

 

• Explain that withholding reimbursement for healthcare after patients receive infections or bed sores ultimately punishes the patients.  Suggest that Medicare reward optimal patient outcomes with higher reimbursement rates instead of denying reimbursement altogether for errors. Explain that determining what is and is not preventable is at best a grey area, and that some patients will be denied care as a result.

 

• Write letters to the editor of your local newspaper explaining the Bush and Republican attack on Americans’ health.

 

• Blog about health issues, and how your health is being affected.

What Goes Around, Comes Around

One need not travel far to read the current Republican/Democratic argument about healthcare.  It goes like this:

‘There’s another fellow,’ muttered Scrooge; who overheard him: ‘my clerk, with fifteen shillings a week, and a wife and family, talking about a merry Christmas. I’ll retire to Bedlam.’

This lunatic, in letting Scrooge’s nephew out, had let two other people in. They were portly gentlemen, pleasant to behold, and now stood, with their hats off, in Scrooge’s office. They had books and papers in their hands, and bowed to him.

‘Scrooge and Marley’s, I believe,’ said one of the gentlemen, referring to his list. ‘Have I the pleasure of addressing Mr. Scrooge, or Mr. Marley?’

‘Mr. Marley has been dead these seven years,’ Scrooge replied. ‘He died seven years ago, this very night.’

‘We have no doubt his liberality is well represented by his surviving partner,’ said the gentleman, presenting his credentials.

It certainly was; for they had been two kindred spirits. At the ominous word ‘liberality,’ Scrooge frowned, and shook his head, and handed the credentials back.

‘At this festive season of the year, Mr. Scrooge,’ said the gentleman, taking up a pen, ‘it is more than usually desirable that we should make some slight provision for the Poor and destitute, who suffer greatly at the present time. Many thousands are in want of common necessaries; hundreds of thousands are in want of common comforts, sir.’

‘Are there no prisons?’ asked Scrooge.

‘Plenty of prisons,’ said the gentleman, laying down the pen again.

‘And the Union workhouses?’ demanded Scrooge. ‘Are they still in operation?’

‘They are. Still,’ returned the gentleman, ‘I wish I could say they were not.’

‘The Treadmill and the Poor Law are in full vigour, then?’ said Scrooge.

‘Both very busy, sir.’

‘Oh! I was afraid, from what you said at first, that something had occurred to stop them in their useful course,’ said Scrooge. ‘I’m very glad to hear it.’

‘Under the impression that they scarcely furnish Christian cheer of mind or body to the multitude,’ returned the gentleman, ‘a few of us are endeavouring to raise a fund to buy the Poor some meat and drink, and means of warmth. We choose this time, because it is a time, of all others, when Want is keenly felt, and Abundance rejoices. What shall I put you down for?’

‘Nothing!’ Scrooge replied.

‘You wish to be anonymous?’

‘I wish to be left alone,’ said Scrooge. ‘Since you ask me what I wish, gentlemen, that is my answer. I don’t make merry myself at Christmas and I can’t afford to make idle people merry. I help to support the establishments I have mentioned-they cost enough; and those who are badly off must go there.’

‘Many can’t go there; and many would rather die.’

‘If they would rather die,’ said Scrooge, ‘they had better do it, and decrease the surplus population. Besides-excuse me-I don’t know that.’

‘But you might know it,’ observed the gentleman.

‘It’s not my business,’ Scrooge returned. ‘It’s enough for a man to understand his own business, and not to interfere with other people’s. Mine occupies me constantly. Good afternoon, gentlemen!’

Seeing clearly that it would be useless to pursue their point, the gentlemen withdrew. Scrooge resumed his labours with an improved opinion of himself, and in a more facetious temper than was usual with him.

Senators’ Revolt and The Defense Takes The Field

This is why I admire the Kaiser Daily Health Policy Report.  It posted a very deep and broad listing of actions, measures and groups working in opposition to the Bush offensive against S-CHIP.

New York is already in court against the Bush administration’s strangling restrictions.

Forty four senators sent a letter to Bush appealing for him to lift the odious enrollment compliance regulation (it states that 95% of all eligible children be enrolled, and the best practice is in the range of 65-70%).

Current authorization for SCHIP expires at the end of the month.  Contact your senator today to express your view that S-CHIP eligibility must be allowed for states to determine the baseline given cost of living variabilities. The Senate must have enough votes to override Bush’s veto.  Or else.

Or Else?

In our names.