Protect health access for kids, seniors

Congressional lawmakers, fresh from their August recess, have a unique opportunity this month to ensure health care access for two of the nation's most vulnerable groups -- children and seniors. Congress must not fail.

Just before adjourning last month, the House passed the CHAMP Act, which would reauthorize the State Children's Health Insurance Program and prevent two years of Medicare physician payment cuts. The Senate then passed an SCHIP reauthorization measure without any Medicare physician payment relief.

Lawmakers now must iron out the differences between the two bills. It is essential that the final bill not only renew SCHIP but also reverse physician reimbursement cuts of 10% in 2008 and 5% in 2009. The American Medical Association is fighting intensely for both. With SCHIP set to expire Sept. 30, Congress must act quickly.

In terms of patient access, the stakes can't be overestimated. In an AMA poll of nearly 9,000 physicians, 60% said next year's 10% cut would force them to limit the number of new Medicare patients they treat or stop seeing beneficiaries altogether. Doctors simply cannot absorb a financial hit of that magnitude.

The House bill would preserve seniors' and disabled patients' access to doctors by replacing the next two years of physician pay cuts with 0.5% increases each year. The measure is not without problems, however. The AMA is working to remove Medicare provisions dealing with physician-owned hospitals and imaging services.

As for SCHIP, a congressional failure to reauthorize the program would devastate children's health care access. About 6 million children (and about 600,000 adults) rely on this program.

Reauthorizing SCHIP at $25 billion -- its level for the past five years -- is not an option. That amount would not be enough to cover the children who are currently enrolled, let alone the roughly 2 million uninsured kids who are eligible for the program, but not enrolled.

Fortunately, the House and Senate bills would increase funding by $50 billion and $35 billion over five years, respectively. This would provide enough money to extend coverage to all eligible, uninsured children.

The House measure would not change states' existing family income limits. About half of the states cover children from families up to 200% of poverty, and the other half cover kids from families above that limit. The most generous level, in New Jersey, is 350% of poverty. The Senate legislation would allow states to cover children in families earning up to 300% of the federal poverty level.

Some Republicans, including President Bush, have said the SCHIP expansions envisioned in the House and Senate bills go too far. Bush's budget proposed a $5 billion increase in funding over five years and an eligibility limit of 200% of the federal poverty level. On Aug. 17, the Bush administration issued new standards that make it more difficult for states to cover children from families above the 250% mark. Republican critics argue that the House and Senate measures are a step away from private coverage toward nationalized health care.

But this argument ignores the statistic that 70% of children on SCHIP are enrolled in private health plans that contract with the states. The remainder are in public plans operated by the counties or in fee-for-service SCHIP.

With about 9 million U.S. children lacking insurance, Congress should make sure the funding level it settles on is enough to enroll uninsured children who are eligible for SCHIP.

Congress already has found two sensible ways to pay for Medicare payment relief and the SCHIP expansion. To help prevent the Medicare physician payment cut, the House bill would end overpayments to private health plans operating in the program. It is only fair that Medicare Advantage be on equal footing with the program's traditional component.

The House and Senate measures would pay for the children's insurance expansion by increasing the federal tobacco tax (currently 39 cents) by 45 cents and 61 cents, respectively.

This funding stream would have the added benefit of deterring people from smoking. The Campaign for Tobacco-Free Kids estimates that every 10% increase in cigarette prices reduces youth smoking rates by 6.5% and adult rates by 2%.

Passing these two priorities with these two funding sources would be a win-win for the nation. Access to care for seniors and children would be safeguarded, smoking rates would fall and a serious distortion in Medicare payment policy would be eliminated.