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The Capitol building in Washington, D.C., in April 2014.
(Nicolas Raymond/Creative Commons)
By David Sarasohn
As Congress returns Monday from its two-week spring recess, there's a wild, unfamiliar excitement, an unexpected Washington anticipation completely unrelated to the opening of the Nationals' season or the return of the cherry blossoms.
It's the idea that Congress might actually do something.
Americans had almost forgotten what the feeling was like.
And for Oregon children, it's a vitally needed step - if to some degree a baby step, dragged along like a younger sibling by something larger.
Over the last 20 years, the Medicare formula would 17 times have sharply reduced payments to doctors - a problem if you want doctors to accept Medicare patients. So 17 times, Congress applied a one-time "doc fix" to keep the cuts from happening. It expressed the basic congressional strategy - short-term warding off disaster.
But last month, House Speaker John Boehner, R-Ohio, and Minority Leader Nancy Pelosi, D-California, cut a deal to change the formula, which passed the House overwhelmingly. (The bill's new revenues don't come close to meeting its costs, but you can't have everything.) It's expected to come up almost immediately when the Senate returns.
The bill also includes, like a lollipop at the doctor's office, an extension of the Children's Health Insurance Program, which would otherwise run out of money in September -just about when school starts. With CHIP, the feds pay most of the cost of insuring 8 million low- and middle-income children. CHIP, now covering more than 68,000 Oregon kids, is at the core of the state's Healthy Kids program, which dramatically reduced the proportion of uninsured children in the state.
Oregon imposed an insurance tax to come up with the state's share for the program, and later claimed (to some controversy) to have reduced its number of uninsured children at the fastest rate in the country.
But for a program already authorized until 2019 by the Affordable Care Act, the bill only funds CHIP for two years instead of four - although it's just a matter of $5 billion to $8 billion in a $200 billion bill.
Some lollipops are less tasty than others.
Complained Sen. Sherrod Brown, D-Ohio, "How do we leave here taking care of the doctors permanently and shortchanging children, giving them only two years of health insurance?"
It's also a problem for grownups, notably for state officials who have to do long-term health policy planning. As we've seen over the past two years, Oregon doesn't need anything to make that process any harder than it is.
"I would very much like to see SCHIP extended for four years," declared Oregon Sen. Ron Wyden, the ranking Democrat on the Senate Finance Committee, on Thursday. He pointed out that every Senate Democrat has endorsed the longer extension, and suggested that if the bill had originated in the Senate instead of the House, it would have been included.
With just a two-year extension, said Wyden, "It turns it into yet another political issue. It will come up in the presidential campaign, and we'll hear from the people who want to roll it back."
Critics of the program have already been heard from, with earlier Republican proposals on the extension cutting back both coverage and enrollment. "We've been asking for (CHIP) renewal for more than a year," said Bruce Lesley, president of First Focus, a Washington, D.C., children's advocacy group. "If we kick it down the road two years, then in nine months we'll be back here having this discussion all over again."
Of 39 governors responding to a survey, only two wanted the extension limited to two years. Supporters of extending funding for at least four years included such conservative Republican heavyweights as Scott Walker of Wisconsin and Sam Brownback of Kansas.
The decision lands particularly heavily around here.
"The federal support for insuring children has been really critical, and has resulted in nearly all children in Oregon getting coverage," says Janet Bauer, a policy analyst at the Oregon Center for Public Policy.
"The longer time period provides more stability for policy in Oregon. To go back and worry about funding for children would be a great distraction."
And on health care, as we've recently shown, Oregon doesn't need any distraction.
The Senate is likely to take up the bill as soon as it gets back, and the CHIP extension won't be the only issue. But it affects millions of children, and dozens of state budgets, and puts into question some of our biggest health care advances.
The difference between two years and four years might not seem like much.
But when you're five years old, two years is a lot.
David Sarasohn's column appears on Wednesdays and Sundays. He blogs at davidsarasohn.com.