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O'Malley to Bush: Rescind Insurance Rules for Kids

Maryland's governor is among those speaking out against new federal rules that would make it harder to enroll middle-income children in a popular government-subsidized health insurance program.

In a strongly worded letter to President Bush last week, Gov. Martin O'Malley (D) called for rescinding the rules, which he said would result in 3,700 Maryland children losing health insurance provided by the jointly funded state-federal program.

"At a time when every Governor in the country is struggling to find ways to decrease the rolls of the uninsured, these new mandates will do the opposite," O'Malley wrote. "They will increase the number of vulnerable children who will suffer the short and long-term consequences of lacking basic health insurance in the earliest years of their lives."

O'Malley objected to a provision in the rules that requires states to cover 95 percent of children in families earning less than twice the poverty level before they can offer services to children in families with slightly higher incomes. Maryland has some of the highest income thresholds in the nation, allowing children to be covered in families earning three times the poverty level.

The Bush administration has argued that the rules are needed to keep the 10-year-old program focused on families that earn too much to qualify for Medicaid but cannot afford their own insurance. Allowing middle-income children to enroll could prompt them to drop private coverage, the administration has argued.

O'Malley said that he understands those concerns but that Maryland has "established reasonable restrictions . . . to guard against that phenomenon."

O'Malley did not go as far in his letter as New Jersey Gov. Jon S. Corzine (D) did last week. He pledged to disobey the rules if they take effect as scheduled in August.

The fate of the program is part of a larger ongoing battle between Bush and Democrats in Congress, who would like to give states more flexibility and significantly expand the program. The program will expire at the end of the month if Congress does not reauthorize it or pass a temporary extension.

By Phyllis Jordan  |  September 17, 2007; 10:10 AM ET
Categories:  John Wagner  
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Comments

Wow. Where are all the MD GOP O'Malley-haters? I don't know if they even want to touch this one. How could anyone actually take the Bushie-side and justify denying Maryland children healthcare? I don't always agree with O'Malley, but I'm proud of him on this one and proud of Maryland for the stand we are all taking with the Governor.

Posted by: Donny | September 17, 2007 10:46 AM | Report abuse

Donny, one merely has to look at how single-payer health systems really work to understand why all thinking people oppose socialized medicine in the United States.

More bad news for you, the Soviet Union collapsed because socialism doesn't work.

Posted by: Rufus | September 17, 2007 12:38 PM | Report abuse

Well, I asked. And they answered. Rufus, do you and the other Bushies really expect anyone in Maryland to believe that only the Soviet Union can provide healthcare to children. I KNOW you do not speak for the entire MD GOP. Many GOPers actually believe we America can measure up - and would be so bold as to back a Dem Governor for taking the right stand. With all due respect, lets keep Maryland at the top of the quality of life scale. Soviet Union? Thats funny.

Posted by: Donny | September 17, 2007 1:52 PM | Report abuse

What ever happened to the GOP being about small government? Shouldn't it be up to the states to determine who they should subsidized health care for?

Posted by: terp | September 17, 2007 2:02 PM | Report abuse

If the Post worked as hard at reporting real news as it does at making O'Malley look like a hero, we might get a real story here one day. I guess when reporters share political ideals with a corrupt one-party government you get hard-hitting reporting like this

Posted by: WaPost4O'Malley | September 17, 2007 2:24 PM | Report abuse

P.S. I don't disagree with O'Malley's position on this issue, just the political grandstanding of the letter to Bush. The Post's Maryland beat just spits back the agenda fed to them by O'Malley's communications office, in stark contrast to their handling of the previous administration(who couldn't even get press releases mentioned).

Posted by: WaPost4O'Malley | September 17, 2007 3:31 PM | Report abuse

Without instantly providing the knee-jerk anti-Bush response, someone tell me what is the problem with making sure that a program such as this is limited to the people that actually need assistance from it in order for it to remain in place?

Maybe Bush explained all of this when O'Malley chose to act as if he were sleeping during the State of the Union address. Remember the cute photo posted here? After acting like the juvenile political hack that O'Malley is, why should he expect the Bush Administration to listen to anything he says?

Posted by: BG from PG | September 17, 2007 3:33 PM | Report abuse

With all due respect, why should Bush get a "pass" on trying to scrooge kids out of healthcare? Fellow tax payers, we pay a lot and this president wants to route all our hard-earned dollars to Halliburton and the Saudi Royal Family via his dad's "petro-consulting" firm - while we argue whether kids in Maryland should be able to get medicine. I don't like to see the world in "black and white", but there dons not seem to be any gray area in this fight. Bush and Cheney on one side and O'Malley and Maryland on the other. I was actually hoping MD GOP would be smarter adn more loyal to their state. I've not given up hope.

Posted by: Donny | September 17, 2007 8:30 PM | Report abuse

Why do people only bring up the Soviet Union when talking about socialized health care. What about France, Canada, and the UK? Please don't say what about the "long waits" because medicaid recipients in America have to wait a long time too!

Posted by: Disheartened | September 18, 2007 10:48 AM | Report abuse

Once again, folks are avoiding facts by hiding behind vague, distorting bromides and personal attacks. Let's try to add a little more light and a little less heat:

The new rules don't absolutely prevent states from expanding their programs to middle-income kids. However, states are now required to demonstrate that they are serving (essentially) all of the lowest-income kids *before* they expand to serve higher-income (middle-income) kids. Doesn't that seem like a reasonable requirement - that we ensure that we have met the needs of the poorest, before we expand to help those who are better off?

The Federal government does have a legitimate interest in helping define the focus of this program, as they are footing a significant portion of the bill. Insomuch as the Federal funding is a guaranteed match of State funding, the rules are necessary to ensure that States don't engage in a back-door expansion of the program beyond it original intended mission, creating a substantial fiscal liability for the nation.

Most social welfare programs have some level of needs-test, and you can argue about where that line should be. However, many states have sought to expand the S-CHIP programs to serve ever higher income, beyond the poor into the middle class, with some folks viewing the S-CHIP another step towards universal government health insurance (first cover the poor kids, then cover middle income kids, then all kids, then cover the poor parents, etc.). Reasonable minds can differ on the wisdom of universal government health insurance (socialized medicine) for kids (and adults, for that matter), but if we are truly intending to change this program, it should be done as the result of significant public debate in Congress.

Furthermore, nothing prevents a state from using its own funds if they believe the expansion of their S-CHIP program is a priority and the best way to solve the health insurance challenges. But why should the Federal government be forced to subsidize that state's approach, just because they use the S-CHIP vehicle? If O'Malley wants to continue to expand the M-CHIP program, let him find the fund within the state budget. If this is a priority for the citizens of Maryland, then they should be willing to pay for it, and O'Malley should be able to make his case. Absent that, O'Malley's letter is little more than an attempt to blame Bush for his (O'Malley's) own inability to fund a program, and an attempt to shift Maryland's problem off onto the nation at large.

I'm a fan of the S-CHIP program, and I was happy when Governor Ehrlich was able to expand the program, but I don't think placing some limits on the program makes Bush a "scrooge" or a heartless, evil man. Respectfully, Donny, there's lots of grey area on this issue - but you have to be willing to look at things from more than one perspective.

Posted by: MD voter | September 18, 2007 12:05 PM | Report abuse

MD Voter, I like your delivery, but you are only delivering parts of this story and not the final analysis. The limit you mention is not ALL of the affect. Also, in the final analysis, do you agree that thousands of MD children will be uninsured? While I respect you analysis, to those affected kids, it IS a "black and white" issue.

Posted by: Donny | September 18, 2007 1:16 PM | Report abuse

Donny, actually, MD Voter covered pretty much all of the CMS order. What was he/she forgetting?

As far as this affecting "thousands of kids," I don't agree. Most of the kids in the 250% to 300% range are covered by private insurance. Furthermore, the rate of uninsured kids is fairly high for kids who are already covered by the program. It makes much more sense for Maryland to focus on covering poor kids rather than trying to sign up new kids who come from middle class families (and who likely already have insurance available).

Posted by: MK | September 18, 2007 3:40 PM | Report abuse

Thanks for the response, but I think some folks and all the Bushies are fantasizing overtime about an America where everyone magically has health insurance without the means or assistance. Please be real.

Posted by: Donny | September 18, 2007 8:04 PM | Report abuse

No, I think people are saying that it is OK for the federal government to put limits on a program where it provides the bulk of the money to ensure that poor kids are served before middle class kids and adults. Makes sense to me.

Posted by: MK | September 19, 2007 9:12 AM | Report abuse

Donny, I do no dispute that there are many (even "thousands") of uninsured kids in Maryland. What I do challenge is numerous unstated assumptions in your post, such as: a) all of those kids are uninsured due to poverty; b) the change in the Fed rules will absolutely increase the number of poor kids that are uninsured; c) it is the roll of the Feds to provide insurance for kids at 200 and 300 percent of poverty, even if private insurance is available (but the parents choose not to avail themselves of that option); d) that the State can only address this problem with Federal funds; e) that a government program (Fed or State) is only (much less best or most efficient) way to address the issue of uninsured kids.

I have no illusions about the challenges of achieving universal health insurance coverage and (more importantly) containing health costs. However, it appears you are in a fantasy wherein government programs are the only solution to problems.

Will this move result in more kids being uninsured? Perhaps - I'll even give you probably - just as Gov. O'Malley's decision to put more money into school construction rather than expanding the M-CHIP program resulted in fewer kids being covered than might have otherwise availed themselves of this program. It's black and white - just like grey.

Posted by: MD Voter | September 19, 2007 2:35 PM | Report abuse

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