Anxious but hopeful, those who work with the poor and the working poor are awaiting the Obama administration's first moves on behalf of the disenfranchised.
The State Children's Health Insurance Program (SCHIP) is among the new president's top priorities. That's welcome news, advocates say, as more people lose jobs and health insurance in a worsening economy.
Created using Pennsylvania's state-run CHIP program as a model, SCHIP provides states with federal money to cover uninsured children up to age 18 in families with income above Medicaid eligibility levels but who cannot afford health insurance.
Bipartisan bills to increase SCHIP funding were twice passed by Congress and twice vetoed by President George W. Bush, though 80 percent of Americans supported the legislation, according to various polls. Funding for the SCHIP program ends on March 31.
The House of Representatives passed a bill on Jan. 14 that would take the program from $167 million a year to $312.5 million in each of four years, an 87 percent increase.
The Senate has taken up the bill, and until a debate erupted yesterday, legislators hoped to have new SCHIP legislation on Obama's desk in a few weeks.
When it finally gets hammered out, "the president will sign it," U.S. Sen. Bob Casey (D., Pa.) said in an interview earlier in the week. Casey is known for his work on poverty issues and is considered a friend of the president.
"I had trouble understanding why Bush voted against it. It was ridiculous. This is a wildly successful government program that works with private insurers to give children coverage."
Casey is especially tied to SCHIP because his father, Gov. Bob Casey, was one of the program's creators in Pennsylvania in 1992. It became a national program in 1997.
Trouble in the Senate cropped up yesterday as Republicans bristled at changes Democrats made in the newest version of the SCHIP bill.
Democrats want to eliminate a five-year waiting period for new legal-immigrant children to enroll in the program (Pennsylvania has no such requirement). Also, identity and income requirements would be loosened. Republicans have vowed to fight those measures.
Until yesterday, the SCHIP legislation had few known detractors, according to Peter Adams, deputy insurance commissioner for CHIP with the Pennsylvania Insurance Department.
In the past, some said they were concerned that the program moved the government into the insurance business. That was one of Bush's worries.
But the insurance is through private companies, and the program is paid for by tobacco taxes, Adams said. The federal government pays for two-thirds of the cost in Pennsylvania. The state puts up the rest, much of it from tobacco taxes, according to Ann Bacharach, special projects director of the Pennsylvania Health Law Project.
The legislation comes at an important moment, said Adams, whose department will release a report tomorrow showing that the number of people with private insurance decreased 4 percent in the state between 2004 and 2008. At the same time, the number of people on Medicaid and CHIP increased by 4 percent.
The nonprofit advocacy group Public Citizens for Children and Youth in Philadelphia says there has been a 40 percent increase in calls from parents needing help to pay for their children's health insurance over the last year.
"We are talking to families who never thought they'd need a safety net before," said Colleen McCauley Brown, director of health policy for PCCY.
Currently, there are 183,891 children in Pennsylvania's CHIP, up 11 percent from a year ago, Adams said.
In Philadelphia, CHIP enrollment increased from 26,611 in October 2008 to 28,273 this month, according to figures provided by Cathleen Palm, a statewide child advocate.
Blame the economy for the increases, she said.
In that same time frame, CHIP enrollment went from 7,753 to 7,984 in Bucks County; 5,170 to 5,355 in Chester County; 7,793 to 8,151 in Delaware County; and 8,502 to 8,732 in Montgomery County.
There are about 90,000 uninsured children in the state who are eligible for CHIP aid but are not receiving it, Adams said.
Many of these children's parents have never heard of CHIP, are suspicious of a government program, or experience language barriers, said Sharon Ward, director of the Pennsylvania Budget and Policy Center in Harrisburg.
In New Jersey, there are 129,000 children enrolled in the state's version of CHIP. But there are 300,000 uninsured children, according to Ray Castro, SCHIP expert with New Jersey Policy Perspective, a nonprofit research group.
"We haven't done a good enough job of outreach," Castro said. "Too many parents simply aren't aware." Many of the uninsured are the children of legal immigrants who have language problems and are suspicious of government, he added.
Outreach is considered to be much better in Pennsylvania, where the state has used, among other means, TV commercials to tell residents about CHIP.
"I saw a commercial," said Rickie Griffin, a 50-year-old West Philadelphia widower and father of two who said he was recently laid off from Tasty Baking Co. Though he had no job, his daughters were receiving Social Security payments and the family was deemed to have too much money for Medicaid.
"What was I going to do?" Griffin said. "My daughter's teeth were messed up. When your little one is hurting, that makes you hurt more. But I got on CHIP and they took care of it. Oh, it's fantastic."
In Pennsylvania, which has a "cover all kids" policy, every uninsured child is technically eligible for health insurance under CHIP or Medicaid.
The very poorest have Medicaid. For families of four making up to $42,000 a year (which is about twice, the federal poverty definition of $21,200), CHIP is free.
If families of four make between $42,000 and $63,000, they must pay an average monthly insurance premium of $40 to $64 per child.
A family of four making more than $63,600 can get insurance at a cost of $161 per child per month.
As senators battle, advocates say the increase in Pennsylvania CHIP enrollment will only continue and the March 31 deadline is approaching.
"A lot of kids' parents lost employment and a lot more will be turning to CHIP," said Leonardo Cuello, executive director of the Health Law Project. "We're worried that we'll be getting a flood of new applicants."