Health-care reform shouldn't hurt kids

NO CHILD WORSE OFF.

As debate on health-care reform began Monday - finally - in the U.S. Senate, the intramural struggle among Democrats continued: Who would win the battle over the public option? What would the bill say about abortion? And in the legislative arm-wrestling over getting 60 votes to block a Republican filibuster, who would blink first: "progressives" or "ConservaDems"?

But here's one issue on which most senators (yes, even some Republicans) should agree: Health-care reform should not leave children at more risk than they are now. And they could be.

The version of reform that passed the House of Representatives a few weeks ago could leave millions of kids with reduced coverage and increased costs, according to many child advocates. In the House bill, the State Children's Health Insurance Program would end in 2013 and be absorbed either into Medicaid or into the health insurance "Exchange" created by the legislation.

SCHIP offers free or reduced premiums for health insurance for kids from low-income families - and includes the kind of preventive screenings that can make a critical difference for the rest of their lives. The new insurance Exchange, scheduled to debut in 2013, would allow families that don't get insurance through an employer to choose from an array of private plans (and maybe a public option).

The idea behind immediately melding the two programs - one that is championed by many people who have supported SCHIP in the past - is that enrolling whole families in the exchange would increase insurance coverage overall. Besides, since individual states manage the SCHIP program, it could be subject to cuts if the economy tanks (even more).

But an analysis sponsored by First Focus, a bipartisan child-advocacy program, found that families would pay significantly more to the Exchange for their kids' health care than under SCHIP. Depending on their incomes, families now pay between 0 and 2 percent of treatment in SCHIP. In the Exchange, those same families would pay between 5 to 35 percent of their children's health costs. Not to mention that SCHIP would end just as the Exchange would be starting up. That could provide some pretty large cracks for families to fall through.

So an amendment to the Senate bill introduced on Monday by Sen. Robert P. Casey Jr., D-Pa., makes sense. The Senate version of the health-care bill extended SCHIP to 2019, but didn't fully fund it. Casey's amendment would do that - and more. It would increase the federal share of funding, make it easier to apply and eventually increase eligibility for families making 250 percent of the federal poverty line - that is, a family of four now making under $55,125. At the same time, Casey's amendment would require a report in 2016 that would compare coverage for kids under SCHIP with the coverage under the health-care Exchange. And may the best deal for children win.

As Casey points out, no one debating the health-care-reform bill is suggesting that Medicare, Medicaid or the Veterans Administration health-care plan be absorbed into the Exchange - and neither should the plan that works best for children.