|
|
Insuring Children May Squeeze Seniors
By Ricardo Alonso-Zaldivar,
LA Times
March
26, 2007
The Democratic Congress, eager to do something that would be popular with voters, is moving to provide healthcare coverage to millions of uninsured children this year, but there's a catch: Senior citizens enrolled in a popular Medicare program may have to help pay the bill.
That could turn what started as a feel-good plan to help the children of the working poor into a tricky exercise in shifting generational burdens. Such trade-offs may soon become a central theme of American politics, experts say, because the federal deficit is large and the bills for supporting baby boomers in retirement are about to start coming due.
"The budget squeeze is on, and in some ways this is the first salvo," said Adam Carasso, an analyst at the Urban Institute, a nonpartisan policy research group in Washington. "It's getting to the point where you are going to have to ask the dreaded question: Is it children or the elderly?"
He added, "The way we have allocated our spending, it's coming down to an either-or proposition."
Lawmakers want to provide coverage to as many as 6 million of an estimated 9 million uninsured children, by increasing federal spending as much as $60 billion over the next five years. But budget rules designed to curb the deficit require new expenditures to be offset by tax increases or cuts in programs.
To help meet the cost, Congress is considering trimming payments to Medicare managed-care plans. The privately run alternatives to traditional programs serve about 8 million senior citizens, including those in health maintenance organizations. If funding is reduced, the plans may cut dental, vision and other benefits.
The new funding for children would be used to expand the State Children's Health Insurance Program, or SCHIP, as well as Medicaid. Known as Medi-Cal in California, Medicaid provides coverage for the poor. SCHIP is called Healthy Families in California, and serves children in low- to moderate-income working families.
Expanding the programs could help people like 5-year-old Kayla Cervantes of East Los Angeles, a second-generation Californian who has had no health insurance for about half of her life. Her parents make too much money to qualify for insurance through SCHIP and other government programs, but not enough to afford private coverage.
Their backup plan if Kayla gets sick is to take her to a doctor in Mexico, where they have relatives.
Maria Rosales, Kayla's mother, said her husband paid $600 a month at one point for family coverage through his employer. (The company pays only for the father's insurance.) "We can afford about $200 a month," Rosales said. "He had to cancel it."
When Kayla caught a bad cold in December, with a cough that wouldn't let her rest at night and a fever that hit 102 degrees, the family went to the doctor in Mexico. It cost about $40 for an examination and prescription antibiotics.
"Today she can play with her friends, but anything can happen," Rosales said. "She could fall, and that would be a big bill."
Fifth-grader Nia Wilson of Orlando, Fla., has to miss school some days because her allergies become unmanageable and her mother can't afford prescription medicine.
"I think it is very important for seniors and the disabled to have benefits, but what happens to families in the middle who are left out?" said Nia's mother, Pamela Wilson, who works two jobs.
Congress must act this year to renew legal authority for SCHIP, and Democrats want broader coverage for children to serve as a down payment on healthcare for all Americans.
But seniors with Medicare are getting a good deal from HMOs. The plans are experiencing an enrollment boom because they can offer richer benefits than traditional Medicare.
The plans are able to provide such benefits because a previous Republican-led Congress created a generous payment system for them. The plans get about 12% more than it costs to cover Medicare recipients in the traditional program, a nonpartisan congressional agency estimated; the payment bonus was established to coax HMOs into serving broader areas of the country.
Equalizing the payments would save about $65 billion over five years.
"It would be stupid and immoral not to take this money back and use it more effectively, either within Medicare or for children," said economist Len Nichols, director of healthcare issues for the nonpartisan New America Foundation think tank. "This is relatively a no-brainer."
But health insurance companies have pledged to fight cuts in managed care. The industry says its analysis suggests congressional experts may be exaggerating the amount that Medicare is overpaying. Moreover, the added benefits are helping millions of seniors stay healthy, and many of the seniors are minorities or have low incomes.
"I don't think a choice between adequate care for seniors and adequate care for kids is the right debate," said Jay M. Gellert, chief executive of HealthNet Inc., which is based in Woodland Hills and is a leader in the industry. "I think that is a false choice, and each program has to be debated on its own merits."
The insurance industry wants Congress to guarantee coverage for all children, but to find other ways to pay for it. The Senate, in a nonbinding vote on the budget Friday, suggested raising tobacco taxes.
HMOs and other group providers have an ally in the Bush administration, which is resisting cuts in the bonus payments because it sees managed-care plans as a crucial component of Medicare's future.
But AARP, the large lobbying group for seniors, says the bonus payments are "inequitable and fiscally irresponsible." An AARP official said the group would not stand in the way of using at least part of the savings to expand coverage for children.
The crucial decisions will probably be made in Congress. Opponents of the cuts are trying to sway lawmakers by mobilizing older managed-care beneficiaries to praise their plans.
Lawmakers from both parties, most governors and much of the medical establishment agree that it's important to expand coverage for children, but there is no consensus on how to pay for it.
The conflict illustrates how hard it may be to move forward on broader healthcare issues that aim to expand coverage and control costs.
In the Senate, Republicans may be able to block the proposed cuts in Medicare managed-care plans. Democrats have only a one-vote margin in the Senate.
"It will be tough to get it through," said Sen. John D. Rockefeller IV (D-W.Va.), who heads the subcommittee that will write the children's bill.
In the House, Democrats seem determined to scale back managed-care payments.
"I don't think that differential is justified," said Rep. Frank Pallone Jr. (D-N.J.), who is helping write the legislation. The higher Medicare payments were "put in there by the Republican majority because of their special-interest association with HMOs and the campaign contributions they were making."
Children's programs have been losing ground in the federal budget, an Urban Institute study says.
The analysis found that programs designed to help children usually had tighter restrictions on eligibility and more limits on funding than programs that served seniors.
Although virtually all senior citizens, regardless of income, are covered by Medicare, 11% of children lack coverage.
"I have always felt that kids are neglected," Pallone said. "That's not to say we shouldn't advocate for seniors, but I do think that children have been neglected."
Health problems in children can have expensive consequences later.
"We are starting to connect the dots between what happens in adulthood and what happens in childhood," said Dr. Neal Halfon, a pediatrician at UCLA and author of a recent study on children's health. "Weight gain in childhood is predictive of whether adults get heart disease, diabetes and hypertension. It's the same with mental health conditions — 50% can be diagnosed in kids before they are teens."
Halfon said investing in children's coverage would promote a healthier workforce in the future — one better able to support what he called the "silver tsunami" of retired baby boomers.
"You can line up a bunch of Nobel Prize-winning economists, and they will tell you the return on investment in human capital is greatest when that investment is made early on in life," Halfon said.
"We seem to be missing that point."
ricardo.alonso-zaldivar@latimes.com
|
|
