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<<   作成日時 : 2007/10/18 23:32   >>

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ニュージャージー州で、セーフティ・ネットが縮小
 ニュージャージー州は働く貧困層への小児健康保険提供という野心的な政策により、国内で最も進んだセイフティ・ネットを張った州の一つである。新たな連邦収入資格規則が適応されると、11000人の低中所得層の子どもが連邦小児保険プログラムSCHIP ではカバーされなくなる。医療コストの増加が小児医療保険財源を枯渇させ、Family Care Program の削減が必要となるだろう。ブッシュ大統領による5年間で300億ドルの案では今後数年間で100万人の子どもがプログラムから徐々に脱落してゆくだろうという。
 ニュージャージー州では2001年に資格を連邦貧困基準の最高350%まで、4人家族の年収で 72,275ドルまでに引き上げている。今回の新しい連邦規則である連邦貧困基準の2.5倍を適用すると保険プログラムから除外される子どもが出てくる。
 ニューヨークでは400%に引き上げようとして連邦当局に拒否された。
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In New Jersey, a Safety Net Gets Smaller
http://www.nytimes.com/2007/10/14/nyregion/14coverage.html?_r=1&ref=health&oref=slogin
PLAINFIELD, N.J., Oct. 12 ― Under its ambitious policy to provide children’s health insurance to the working poor, New Jersey has long been one of the most aggressive states in the nation in throwing a wide safety net out for families like the Martinezes of Bayonne, the Palmers of Sicklerville and the Urquizos of North Plainfield.

画像Children’s Eligibility for S-Chip

But the six children in those three families are among the 11,000 children in low- and middle-income families in New Jersey who will no longer be covered by the State Children’s Health Insurance Program, or S-Chip, under new federal income eligibility rules.

Still more would be cut from the program known as New Jersey Family Care as increases in health care costs deplete the children’s health insurance coffers, state health officials said.

According to health care experts, an estimated one million children across the country would be phased out of the insurance program over the next few years under the $30 billion five-year plan proposed by President Bush.

“They are not looking at the consequences of this for families and children that are going to lose out,” said Ann Martinez, 28, an administrative assistant. She said that she earns too much money to qualify for Medicaid, the government health insurance program for the poor, but that she cannot afford the $500 a month it would cost her for coverage for her two children.

Ms. Martinez, who earns $47,000 a year, is covered under her employer’s health plan, but her children are covered by New Jersey Family Care; in 2001, the state raised the eligibility level to allow families like hers earning up to 350 percent of the federal poverty level to qualify ($72,275 for a family of four).

Her son, Jonathan, 13, has high blood pressure and attention deficit disorder. Without the children’s health insurance plan, which covers prescriptions, his medications would cost her $250 a month, stretching a budget that is already squeezed by rent and car payments.

“It’s going to be really sad what happens,” Ms. Martinez said.

New Jersey has the highest income eligibility threshold of any state, but several other states have also raised income caps to cover more families since the program was created in 1997. They would also have to cut children from the insurance rolls, under the new federal rules.

The new rules now cap eligibility at two and a half times the poverty level, but 10 states and the District of Columbia have provided coverage, most of it financed by federal dollars, to children in families earning above that level. Several states, including Connecticut, Maryland and New Hampshire, have put the cap at 300 percent of the poverty level.

New York tried to raise its eligibility threshold to 400 percent of the poverty level, but federal health officials denied the application last month, prompting Gov. Eliot Spitzer, joined by the governors of several other states, to sue the Bush administration over the federal rules.

President Bush vetoed legislation that would have allowed states like New Jersey, with one of the highest costs of living in the nation, to expand coverage under S-Chip, adding four million uninsured children nationwide to the six million covered now.

The bill would have provided $60 billion for the program over five years. It would also have increased eligibility to 300 percent of the poverty level, or $61,950 for a family of four, from the new federal cap of 250 percent, which was announced in August.

Advocates of the Bush administration’s stricter eligibility rules and its spending plan said the program must be reserved for the poorest citizens, not for those in higher income brackets. (Most of New Jersey’s 124,000 enrolled children are from families in lower income brackets.) New Jersey Republicans siding with Mr. Bush said an expansion of the insurance program would give the government far too big a role in health care coverage.

“I’m glad that President Bush stood by his veto threat,” Representative Scott Garrett, Republican of Paramus, said in a statement. “Congress must return to the drawing board and develop a reasonable, bipartisan approach that actually helps our low-income children rather than create a new entitlement for families earning $72,000 per year.”

At ground zero in this raging debate over eligibility and financing is the Plainfield Health Center, where the pediatric unit has brightly colored examination rooms and a waiting room decorated with a brown bear pointing to a caboose and shouting, “All aboard the health train!” On Friday afternoon, the unit was full of patients being treated for asthma, headaches, colds and much worse.

Of the 70 children who are treated daily at the center, about three will lose coverage under the Bush administration’s rules, because their families earn too much. If the state cannot come up with the money to cover the federal share, those children will have to be kicked off the rolls, said Jaspreet K. Sodhi, director of patient financial services.
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“These children will be completely uninsured,” Ms. Sodhi said. “We will never deny treatment, but their families will walk out of here and they will be getting a bill.”

New Jersey state officials, who have also filed a federal lawsuit against the Bush administration challenging the stricter eligibility rules, said they were still weighing their options.

In South Jersey, Syeeba Palmer, a widow, earns too much to qualify for Medicaid coverage for her children, ages 2 and 5, because she receives $2,800 a month from her late husband’s Social Security. Ms. Palmer’s monthly mortgage payment is $2,400, she said. And since she was laid off from her job as a health insurance consultant several months ago, she said it cost an estimated $1,100 a month to continue to cover herself and her children. She decided not to get coverage for herself and to apply for New Jersey Family Care for the children.

“If I lose this insurance, there is no way I can afford it on my own,” she said.

Reina Urquizo, a legal resident from El Salvador, works at a factory in Warren that makes cables for cellphones and other electronics. Her two sons, ages 2 and 9, were enrolled in the children’s insurance program, but they would no longer qualify under the new eligibility rule. While she has private insurance, the family cannot afford to cover her husband.

Children’s advocates and legislators and governors from both sides of the aisle are furiously lobbying House Republicans in an effort to override the veto in a vote scheduled for Thursday. The bill was passed 265 to 159 in the House; to override the veto, 290 “yes” votes would be needed, if all 435 House members vote.

In Connecticut, where Gov. M. Jodi Rell, a Republican, was among dozens of governors urging Mr. Bush not to veto the S-Chip legislation, the legislature has already financed coverage of 17,000 children for the next two years; 3,750 of them now are not qualified under the new rules, officials said. Connecticut may not be reimbursed for those children, but unlike New Jersey and New York, that state had no plans to expand its program.

Children’s advocates said New Jersey had been far ahead of other states, and was considered a model of how to stretch state dollars to cover as many uninsured children as possible.

“This really pulls the rug out from under the state, which was really trying to do the right thing,” said Irwin Redlener, president of the Children’s Health Fund, a national health care and advocacy organization based in New York. “We will be seeing large numbers of children with no immunizations, no asthma diagnosed, and this becomes a real-world horrendous burden for families and children at the end of the day.”

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