Saying no to children.

Byline: The Register-Guard

When it comes to health care, President Bush wants to make sure no one misunderstands his priorities: Keep insurance companies healthy, even if it means allowing a couple of million children here and there to go without medical coverage.

So committed is this president to the heartless ideological goal of limiting government's role in providing health care that he came up with a downright sneaky way to sabotage veto-proof legislation.

After the Senate passed an expansion of the hugely popular State Children's Health Insurance Program with a bulletproof 68-31 majority, Congress left for its August recess. The White House waited until after dark last week to counter with an end run that makes Bush's presidential signing statements look quaint by comparison.

The Department of Health and Human Services sent a letter to state health officials to "clarify" existing policy.

Federal legislation in 1997 set SCHIP eligibility at 200 percent of the poverty level (currently $41,300 for a family of four) to enroll uninsured children whose families made too much to qualify for Medicaid. In SCHIP's 10-year history, states have had flexibility to raise the income limit with federal approval.

Last week, Bush ordered the imposition of stringent new requirements for adding more children to the program. States were forbidden from loosening income restrictions unless they can demonstrate that they already have enrolled 95 percent of the children who currently are eligible. No state has ever come close to signing up 95 percent of its working-poor households.

The requirement isn't just unrealistically high; it's impossible under Bush's current budget proposals, and he knows it. The Congressional Budget Office has said that the president's budget, which seeks $30 billion from 2008 to 2012, is too low to support current levels of enrollment, much less to cover children who are eligible but not enrolled.

It's the cruelest of Catch-22s: States can insure more children if they sign up 95 percent of eligible households, but the federal budget won't pay for anywhere near 95 percent enrollment. Compassionate conservatism as practiced by the Bush administration continues to be little more than a cynical oxymoron.

Oregon is among the states that would like to provide coverage for families earning up to 300 percent of the poverty level. With more than 100,000 uninsured children, the higher limit helps more kids. But Bush maintains that a family of four at 300 percent of the poverty line earns $68,833 a year and ought to be able to pay for its own insurance.

Most experts agree that approximately 5 percent of income is a reasonable outlay for health insurance. In 1996, 16 percent of families at 200 percent to 399 percent of the poverty level spent more than 10 percent of their income on health care. By 2003, 23 percent in that income range were spending more than 10 percent.

Given an average $3,000 annual premium for an individual health insurance policy, a single person would have to earn $60,000 - 600 percent of the poverty level - to keep health insurance costs within 5 percent of income.

It's hard to understand why Bush picked this particular fight. It's a loser on every level.

Nearly two out of three adults support SCHIP for children in families with incomes as high as 300 percent of the federal poverty level, according to a University of Michigan report. A recent Georgetown University poll showed 9 in 10 Americans - including 83 percent of self-identified Republicans - support an expansion of the children's insurance program.

Perhaps this finally will drive a stake through the heart of the stubborn urban myth that Bush is basically a decent guy with a tough job who feels everyone's pain.

When it comes to providing health insurance for kids, it's more accurate to describe the president as basically a tough guy whose policies stand a decent chance of causing everyone pain.