Gov. Ed Rendell reacted strongly yesterday to plans by the Bush administration to scale back a program that offers health insurance to children in Pennsylvania and other states.
"We should not be making it harder for children to get the health care they need," the governor said in a statement. "If the president is serious about market solutions to our health care crisis, he should be expanding, not cutting back, the public-private partnership that has made health insurance affordable for thousands of Pennsylvania children."
Mr. Rendell said that officials are analyzing the new directive and, for now, planned to continue to enroll children as usual in the program.
"We plan to talk with the federal government and will be waiting to see how the U.S. House and Senate react to this situation," he said.
Both houses of Congress have approved increased funding for the Children's Health Insurance Program, but they have yet to reach agreement. The Bush administration is opposed to both bills.
In a letter to state health officials Friday, Dennis Smith, director of the federal Center for Medicaid and State Operations, expressed concern that expanding CHIP could prompt families to drop private coverage.
He presented new guidelines that states would have to meet when they expand CHIP to families above 250 percent of the federal poverty level, about $51,600 for a four-member family.
Pennsylvania, along with a number of other states, already has an expanded CHIP program that extends benefits to families above the 250 percent level. In his letter, Mr. Smith said the new guidelines should not affect current enrollees.
Rep. Jason Altmire, D-McCandless, said he was disappointed but not surprised at the new directive.
"We'll do the best we can to overturn it," he said.
Relatively few families applying for CHIP have access to affordable health insurance through the private market, Mr. Altmire said.
Rising health care costs have prompted employers to drop health insurance or increase cost-sharing for employees, leaving coverage beyond the reach of many families, said Dr. Robert Cicco, immediate past president of the Pennsylvania chapter of the American Academy of Pediatrics and associate director of West Penn Hospital's neonatal intensive care unit.
In his letter, Mr. Smith said states would have to amend their programs to adhere to the new guidelines within a year or face possible "corrective action."
Among other provisions, the guidelines would require children in families above the 250 percent level to be uninsured for at least a year before becoming eligible for CHIP.
In Pennsylvania, children older than 2 in families above the 200 percent level now wait six months before they can qualify.
States also would have to assure, before they could expand coverage above the 250 percent level, that they have enrolled at least 95 percent of their children below 200 percent of poverty in CHIP or Medicaid, which serves people with lower incomes.
In Pennsylvania, about 93 percent of children under 200 percent of the poverty level are in those programs, said George Hoover, the Insurance Department's deputy commissioner for CHIP and adultBasic programs.
"I don't know of any state that's at 95," he said.
Pennsylvania began its expanded CHIP program, Cover All Kids, earlier this year.
Under the program, which received federal approval, families with incomes at 200 percent of the poverty level pay no monthly premiums; those with higher incomes up to 300 percent of the poverty level pay premiums ranging from about $38 to $60 per child.
Families with incomes above 300 percent of the poverty level pay about $150 a month per child.
Joe Fahy can be reached at firstname.lastname@example.org or 412-263-1722.