SCHIPping Away at the Bush Legacy

It's hard to imagine a worse PR move for a politician than to keep children from seeing the doctor. But President Bush seems to relish playing the role of the Grinch who Stole Health Care, promising to veto bipartisan legislation passed this week to reauthorize the State Children's Health Insurance Program (SCHIP). SCHIP is a 10-year old system jointly funded by the states and the federal government that provides health insurance to 6 million middle-class children, mostly those living in families between 200% and 300% of the Federal Poverty Level. In partnership with the program for the poorest of the poor, Medicaid, the federal government currently assists one in four American children with the cost of health insurance.

But there are an estimated 9 million more uninsured children, many of whom are eligible for these programs but not enrolled because the federal government caps SCHIP spending. A bipartisan group of lawmakers in the House and Senate passed legislation this week to allocate an additional $60 billion over the next 5 years. The President is trying to block this expansion. In addition to his oft-repeated veto threat, his administration went on the offensive earlier this month, using its existing authority to kill a New York plan to enroll an additional 70,000 children.

The program enjoys considerable support even within the Republican Party, and the standoff hands Democrats a golden political opportunity. So why is President Bush picking this unpopular fight? The President has previously been willing to part ways with small-government orthodoxy when politically expedient, perhaps most notably when he hammered the costly Medicare prescription drug benefit through Congress in 2003. Indeed, many prominent conservatives have labeled the President an opportunist and a "traitor" to their movement. But the President seems suddenly dogmatic, not only promising to veto this legislation but using his existing authority to block a New York proposal to open SCHIP to an additional 70,000 children in the Empire State.

It’s tempting to conclude that the President, freed by his lame-duck status and approval ratings that can’t fall much further, is simply trying to eek out a conservative legacy before leaving office. But the SCHIP fight seems to be an outgrowth out of a more consistent strategy to balance conservative policy objectives with the need to advance conservative politics against the tide of public opinion. Though the Bush administration was initially heralded as the apotheosis of the conservative insurgency previously lead by President Ronald Reagan and Speaker Newt Gingrich, Mr. Bush confronted a very different public than his predecessors. A 2007 report from the Pew Center for the People and the Press documents that anti-government sentiment peaked with Gingrich’s rise to power in 1994. That year, only 42% of survey respondents agreed that "government is really run for the benefit of all the people," but 55% agreed in 2002. Thirty-three percent of respondents told pollsters they thought "most elected officials care what people like me think" in 1994, while 44% felt politicians valued their opinions eight years later. In 1996 (the first year this question was included in the Pew report), more than twice as many Americans favored "smaller government" offering "fewer services" over "bigger government" offering "more services." Today, this preference for small government has vanished.

The President’s 2003 Medicare prescription drug plan shows his administration practicing a kind of conservative jujitsu: When public demands for federal intervention cannot be sidestepped, it could be used to channel public resources into the private sector. Instead of simply paying for seniors' medicines the way the Veterans Administration does and saving through bulk purchasing power, the program forces seniors to navigate a bewildering array of private plans and leaves them with huge gaps in coverage. But the public rallied against Mr. Bush's 2005 attempt to apply the same logic Social Security, torpedoing his plan to redirect payroll taxes dollars into private investment.

SCHIP expansion not only offends the President’s anti-government sensibilities, but it posses a serious threat to the conservative politics his administration has practiced. Mr. Bush lost the Social Security fight in part because it was a middle-class program—the people who’d paid into the system were going to insist they receive its benefits. But welfare programs are much more vulnerable, since the middle class can be convinced that their tax dollars are being handed over to other, undeserving people. Just months after the President's Social Security plan went down in flames, Republicans were able to cut billions from Medicaid with impunity. By this logic, SCHIP is tolerable as long as it is restricted to a small number of children living on the edge of poverty. But if Congress expands it into a program for a large number of middle-class children, it could create popular support for the government supplying health insurance to the middle class.

The fact that 25% of American children are currently enrolled in federal health insurance programs reflects the appalling number of American children currently live in poverty, not the generosity of government programs. Children’s health insurance today is essentially a welfare program—there are 26 million low-income kids enrolled in Medicare, while 6 million somewhat better-off kids are enrolled in SCHIP. President Bush worries that expanding SCHIP to include more of the middle class would inch federal health insurance away from welfare closer towards a broad-based program with widespread public support. And if government health insurance for children proves popular with the middle class, it could generate support for comprehensive health insurance reform.

This is exactly how the President explained his opposition last week. "The legislation would raise taxes on working people and would raise spending between $35 million to $50 million. [Congress'] proposal would result in taking a program meant to help poor children and turning it into one that covers children in households with incomes of up to $83,000 a year…. Democratic leaders in Congress want to put more power in the hands of government by expanding federal health care programs. Their SCHIP plan is an incremental step toward the goal of government-run health care for every American."

The President has accused Democrats of "putting health coverage for poor children at risk so they can score political points in Washington" by insisting on an SCHIP package he's promised to veto. But it is the President who's playing politics. He's blocking a plan to provide health insurance to millions of children today in a preemptive strike against plans that might cover all 47 million uninsured Americans tomorrow.

President Bush's stand on SCHIP show him to still be a conservative in his heart of hearts. But certainly no one can credibly call him "compassionate" anymore.