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The Bush Administration’s Budget War on Poor Children:Target—Medicaid

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By Marian Wright Edelman

In a recent Child Watch column, I wrote about the Bush Administration’s assault on Head Start in their 2004 Budget. But Head Start is just one front in this budget’s war on poor children. Another of this budget’s radical proposals gives states unprecedented latitude to scale back coverage of vital health care for children and to impose substantial cost-sharing requirements that could restrict children’s access to needed health care.

This proposal would put at risk one in three of the nearly 30 million children receiving health care through Medicaid and the Children’s Health Insurance Program (CHIP). This budget also fails to adequately address the health care needs of the 9.2 million children who still have no health insurance, and the proposals could actually add to the number of uninsured children if states ultimately decide to shift funds away from children or impose unaffordable cost-sharing on families.

Finally, the Bush Administration fails to restore $1.2 billion in CHIP funds that expired from the program at the end of the 2002 fiscal year – a decision that may force some states to drop coverage for some children because of inadequate CHIP resources in future years.

How could this happen? How could our wealthy nation choose to turn back the clock on the progress we have made in ensuring that children have the health care they so urgently need? These proposals reflect this administration’s unjust budget priorities.

Once again, those in power are championing policies that would leave no millionaire, but millions of children, behind. But if enough voters and taxpayers stand up to say “No” and insist on different choices, we can stop them.

The Medicaid and CHIP proposal threatens to unravel a key element of the safety net that assures low-income children a healthy start in life. Medicaid provides eligible children with the healthy start they deserve. States are currently mandated to serve all poor children—a mandate that will continue—and are currently guaranteed federal help if they decide to extend health care to additional low-income children. This promise of early preventive investments and comprehensive health and mental health services for children with disabilities helps to prevent serious illnesses and the need for more costly care in the future.

The Bush Administration is using children to help solve a fiscal crisis that they did not cause. Although children’s health care costs are far less than those of others on Medicaid, the proposed Bush block grant will include both a portion of Medicaid’s dollars for children and the entire investment in the Children’s Health Insurance Program.

Millions of children will then be forced to compete with older people, those with disabilities, and other uninsured adults for scarce dollars. While children make up more than half of the Medicaid enrollees, they account for less than a quarter of Medicaid spending. The average per child Medicaid cost of $1,590 (which includes the costs of children who are severely disabled) is no more than one-sixth the average per person cost of Medicaid for older Americans ($10,312) or persons who are disabled ($9,732).

Many children will be at risk of losing comprehensive health and mental health services and basic protections, as dollars are spread to give less help to more children and adults. Medical services for children in Medicaid, and some CHIP children, must include well-child and well-baby care, immunizations, screenings for hearing and vision, and dental care, as well as all medically necessary treatment for any illnesses, injuries, or disabilities identified in children. Some children in CHIP receive a more limited package of benefits.

Comprehensive quality services are essential for many children, especially those with disabilities and other special health or mental health needs. Cutting back on some to help more will place many children squarely in harm’s way and will certainly end up costing more down the road.

New cost-sharing requirements could also make it more difficult for low-income families to afford continued coverage for their children. Although the Administration claims that it will continue to protect comprehensive health care for the poorest children, health insurance for children in low-income working families will be at risk. Nearly 1.5 million children with severe health care needs who qualify for Medicaid because of their significant medical expenses may also be in jeopardy of losing coverage of needed services.

In his recent State of the Union address, the President committed to “high quality, affordable health care for all Americans." But once again his promises and policies are at odds. Instead of offering a vision and the necessary funding to reduce the number of uninsured children in America, the President is setting their needs aside. He makes no guarantees that his proposals will give more children quality health care. In fact, his proposals could jeopardize the quality care that millions of children are now receiving and may even result in more children being added to the rolls of the uninsured. By eliminating an assurance of comprehensive health care for many children and key protections to ensure access to care, the Bush proposal radically undermines gains made by Medicaid and CHIP that help reduce the number of uninsured children and provide affordable access to the health care they need.

The Children's Defense Fund is asking everyone in America who is concerned about children to call their U.S. Senators and Representatives to say “No” to the Bush Administration’s tax and budget proposals. Call the U.S. Capitol switchboard at (202) 224-3121 and ask for your U.S. Senators and Representatives. We MUST speak up and say "no" to send a powerful and consistent message to those in power. Children need our voice.

Marian Wright Edelman is president of the Children's Defense Fund and a working committee member of the Black Community Crusade for Children (BCCC), whose mission is to Leave No Child Behind®.

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