How to Argue against SCHIP

I like to open with this: “If your goal is to improve the health of low-income children, the State Children’s Health Insurance Program is a bad tool for achieving that goal.”

Then I make as many of the following points as possible.

  1. SCHIP does a bad job of targeting assistance. About 60 percent of children currently eligible for SCHIP already have private health insurance, while 77 percent of those targeted by this expansion (i.e., children between 200-300 percent of the federal poverty level) already have private health insurance.
  2. SCHIP covers four uninsured children for the price of ten. Economists Jonathan Gruber and Kosali Simon estimate that, in effect, 60 percent of children covered by SCHIP expansions already had private coverage.
  3. There is no evidence that SCHIP is the best way to improve the health of targeted children. Economists have found no evidence that SCHIP is a cost-effective way of improving health. Discrete health programs or policies that improve incomes or education could deliver as much or more health for the money.
  4. SCHIP discourages families from climbing the economic ladder. If a single mother of two earning minimum wage in New Mexico increases her annual earnings by $30,000, she pays an additional $4,000 in taxes and loses $26,000 in SCHIP and other government benefits. In other words, her net income would not change, therefore she has no financial incentive to climb the economic ladder. Expanding SCHIP would put downward pressure on even more families’ incomes, which could harm child health.
  5. Like Medicaid, SCHIP makes private coverage less affordable for people outside the program. Under Medicaid (and therefore SCHIP) rules, the government agrees to pay a percentage of what drug makers charge private payers. Economists have found that manufacturers respond by raising prices for private purchasers an estimated 15 percent.
  6. SCHIP would do nothing to address systemic quality problems. According to a recent study in the New England Journal of Medicine, “Expansion of access to care through insurance coverage, which is the focus of national health care policy related to children, will not, by itself, eliminate the deficits in the quality of care.”
  7. SCHIP’s self-interested advocates. Why do you suppose the physician, pharmaceutical, and health insurance lobbies are agitating for health care subsidies that lack any evidence of cost-effectiveness?
  8. This SCHIP expansion taxes the poor to benefit the middle class. Isn’t that just cruel?
  9. Eliminating SCHIP and letting people purchase coverage from out-of-state is a better alternative. The latter would enable families to avoid unnecessary regulatory costs, which the Congressional Budget Office puts at about 15 percent of health premiums. That would benefit SCHIP-targeted families most of all. And it would do so without raising anyone’s taxes, showering subsidies on non-needy families, pulling families into a low-wage trap, or increasing the cost of private insurance. As for eliminating SCHIP, when Congress cut non-citizen immigrants from the Medicaid rolls, contrary to all predictions the number of uninsured non-citizen immigrants actually fell. Why wouldn’t SCHIP families, who are more affluent, fare even better?

Then I like to close with this: “If you’re not interested in the best way to promote child health, not interested in targeting government assistance to the needy, and not concerned about trapping families in low-wage jobs…exactly what is it you are hoping to accomplish?”

Here [audio file] is what happened after I made just a few of these points to left-wing talk show hostess (and frequent Alan Colmes stand-in) Leslie Marshall.