SAUGUS, Mass. — Shocked, fearful and helpless. That’s how Samuel Goncalves felt in 2007, shortly after being diagnosed with lung cancer at the age of 18.
Goncalves, who immigrated to the U.S. from Brazil with his family, had no health insurance. Even though he was a legal immigrant, he didn’t qualify for Medicaid or any other government-run health program. He’d only had a green card for three years — two years shy of the five required by federal law back then.
The five-year waiting period for legal immigrant children to qualify for health assistance was removed last week as President Barack Obama signed into law the Children’s Health Insurance Reauthorization Act of 2009, which renews and expands the State Children’s Health Insurance Program (SCHIP).
SCHIP will enable states to cover more than 4 million uninsured children from low-income families — including legal immigrant children — by 2013, while continuing coverage for 7 million youngsters already covered by the program.
In Congress, the debate over SCHIP was considered by many to be a preview of the upcoming debate over health care reform. Although the U.S. invests about $2 trillion per year in health care, 45 million Americans remain uninsured.
“Even though we’re considered the wealthiest country on Earth, the health and well-being of Americas’ children is worse than that of every other developed country in the world,” said Charles Homer, pediatrician and CEO of the National Initiative for Children’s Healthcare Quality (NICHQ), a Cambridge-based nonprofit organization.
“This bill also provides states with funding for measuring the quality of service,” said Homer. “It not only insures that kids get in the door, but when they do, that the service is as good as it should be.”
For the past two years, NICHQ has worked with a pediatric national committee and pushed SCHIP with several leaders, such as Sen. Evan Bayh, D-Ind.
SCHIP was first enacted in 1997 and signed into law by President Bill Clinton. But the trail from its conception to congressional approval of the reauthorization bill last week was long and rocky.
Since 2007, the House had voted on the proposal seven times. But it faced fierce resistance from Republicans like U.S. Rep. Steve King of Iowa, who denounced the bill as “a foundation stone for socialized medicine.” President Bush vetoed two versions of the bill approved by Congress.
A major reason for the Washington, D.C., gridlock was a proposal by Democrats that SCHIP cover all legal immigrant children without imposing the five-year delay. The version signed into law requires states to verify that children covered by the program are United States citizens or legal residents. But Republicans argued that states won’t be able to offset the costs.
“Whenever the government wants to start a war or to promote tax cuts, they always finds resources,” said Keith P. Jones, CEO of Soul Touchin’ Experiences, a consulting company that helps policymakers and nonprofit organizations understand the needs of minority groups.
“This bill is an investment in America. More of our kids are obese or developing type 2 diabetes in early ages. They are not as healthy today as they were when I was a kid, 25 years ago,” said Jones, whose wife is the daughter of Haitian immigrants.
U.S. Rep. Tom McClintock, R.-Calif., said the children’s health program was “slowly replacing employer health plans with government-paid health plans, with spiraling costs to taxpayers.”
Funding for the bill, estimated at more than $32 billion over four and a half years, will come from an increase in tobacco taxes.
Homer of the NICHQ acknowledges that there is concern over increasing government-run health services too rapidly. He brushed aside the idea of a single-payer system.
“The focus should be more on making sure we cover everyone in the country rather than the administrative aspect of the care we provide,” Homer said.
Jones agrees that a middle-of-the-road solution, combining private and public coverage, can be achieved.
“But we have to be careful,” he added. “In the national dialogue, people don’t talk about health reform in terms of pragmatism, but ideology.”
For Jones, shared responsibility works for individuals “who make sure they are not drunk all the time, but also for governments that must guarantee that someone with the misfortune of having liver disease will be able to receive quality treatment.”
To pay for his son’s cancer treatment, Samuel Goncalves’ father had to pay to extend his private insurance. The best he could get was coverage for 80 percent of Samuel’s much-needed $180,000 tumor removal surgery. That placed a real strain on the entire family. The Goncalveses are still struggling to pay a $50,000 bill, the balance they owe for Samuel’s treatment.
“Anybody who uses a child as a wedge issue is playing dirty,” Jones said. “A child didn’t ask to be here, a child is not in the position of making critical decisions.”
Despite the Obama administration’s success in expanding SCHIP, further health reform measures may be more difficult to achieve.
“The rapidity with which Democrats managed to reauthorize SCHIP should not be taken as a sign that it will be easy to pass broader proposals for expanding coverage to other uninsured populations,” John K. Iglehart, a national correspondent for the New England Journal of Medicine, wrote after the bill’s signing.
“Democrats saw the SCHIP measure as unfinished business from the 110th Congress. Moving on to more ambitious reforms will be more difficult, given the rapidly increasing federal deficit, the competing claims for federal resources, and the determination of Republicans to forestall the growth of public insurance,” Iglehart added.
Nevertheless, Obama believes that a major health care initiative must be “intimately woven into our overall economic recovery plan.” As he has said, health care reform is “not something that we can put off because we are in an emergency. This is part of the emergency.”
