toledoblade.com --

The battle between Congress and the White House over a government health plan for children is the reason Democrats get elected. When a Republican administration tightens the screws on the working poor by making it more difficult for states to insure their offspring, compassionate conservatism loses all meaning. Instead, people see an elitist party led by the privileged few who have no concept or concern with the paycheck-to-paycheck realities of millions of Americans.

But public opinion matters less to the Bush Administration than it ever did. With no re-election to worry about and time running out on a second term, it doesn't have to camouflage its indifference to the troubles of citizens abroad or at home. Still, it did attempt to minimize the impact of a recent policy change revealed to state health officials by letter - in the middle of a month-long congressional recess - that targets children of lower-income families.

The letter, sent last Friday evening by Dennis Smith, director of the federal Center for Medicaid and State Operations, listed new standards to narrow eligibility for a government-subsidized health insurance plan to all but the lowest-income children. The sly maneuver dramatically distorts the original intent of the State Children's Health Insurance Program, or SCHIP. It was designed 10 years ago to help kids whose families earned too much to qualify for Medicaid but not enough to afford insurance on their own.

The popular SCHIP covers about 6 million children, and Congress and the states have been moving to expand coverage to even more lower-income kids so they can receive basic medical care. But the administration, wrote Director Smith, believes those efforts are inappropriately increasing the federal role in health care. His agency, under the Health and Human Services Department, plans to shrink that expansion by making it far more difficult for families to sign up for the program. That will also prevent the program from becoming what the White House calls "essentially a middle-class entitlement."

The position is remarkably callous, even for the Bush Administration, and illustrates a striking disconnect between the White House and a vast number of financially strapped middle-class families slipping hopelessly beyond breaking even. The administration says more restrictive rules imposed on the children's health plan will limit it to the neediest households and discourage its use as a substitute for private health coverage. Yet states have already enacted numerous measures to blunt any attempts to go directly from private health coverage to the public program.

The goal has always been to cover kids whose parents work at jobs that don't provide employer-paid insurance. But by imposing highly restrictive standards that cannot be met, state health officials say the administration will "effectively foreclose the opportunity for states to cover children in families with incomes of about $40,000 to $50,000 a year, depending on the size of family." That means tens of thousands of kids in states that provide or plan to provide coverage exceeding the new Bush policies would become uninsured.

The White House edict on limiting the reach of the children's insurance plan also threatens states that don't implement it within 12 months with "corrective action" from regulators. But states could balk. Too many kids living above the poverty level need a public safety net as much if not more than those in families living below the poverty line. It's why at least 23 states from New York to California have expanded SCHIP to cover more children of the working poor whose incomes are above the poverty level, or $20,650 a year for a family of four.

For a family of the same size making more than 250 percent of the poverty level, the annual income is $51,625. Over a dozen states either cover children in families making that amount or have recently passed laws to do so. What state health officials grasp that the Bush Administration doesn't is that a yearly income of $50,000 a year for a family of four doesn't go far with house and car payments, utilities, food and clothing, and paying double what it cost to fill a gasoline tank a year ago. Plus there's the pile of out-of-pocket medical bills.

Most working couples are grateful just to have jobs. Employer-paid medical insurance is a bonus. Even if there is coverage, meeting deductibles, co-pays, and the percentage of costs not covered can put a lower-income family deeper in debt. It is the children of these households, neither rich nor poor, who are likely to go without health care if the Bush Administration's policy is allowed to continue indefinitely. Nobody likes it - not state health agencies, governors of both parties, or the solid bipartisan base in Congress.

But a President with nothing to lose would rather give tax breaks to the richest Americans or bloated subsidies to the corporate world than health insurance to kids with none. So the maligned middle class turns for relief from those who can relate. It's why Democrats get elected.

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