WASHINGTON — The Democratic Congress, eager to do something that would be popular with voters, is moving to provide healthcare coverage to millions of uninsured children this year, but there's a catch: Senior citizens enrolled in a popular Medicare program may have to help pay the bill.
That could turn what started as a feel-good plan to help the children of the working poor into a tricky exercise in shifting generational burdens. Such trade-offs may soon become a central theme of American politics, experts say, because the federal deficit is large and the bills for supporting baby boomers in retirement are about to start coming due.
"The budget squeeze is on, and in some ways this is the first salvo," said Adam Carasso, an analyst at the Urban Institute, a nonpartisan policy research group in Washington. "It's getting to the point where you are going to have to ask the dreaded question: Is it children or the elderly?"
He added, "The way we have allocated our spending, it's coming down to an either-or proposition."
Lawmakers want to provide coverage to as many as 6 million of an estimated 9 million uninsured children, by increasing federal spending as much as $60 billion over the next five years. But budget rules designed to curb the deficit require new expenditures to be offset by tax increases or cuts in programs.
To help meet the cost, Congress is considering trimming payments to Medicare managed-care plans. The privately run alternatives to traditional programs serve about 8 million senior citizens, including those in health maintenance organizations. If funding is reduced, the plans may cut dental, vision and other benefits.
The new funding for children would be used to expand the State Children's Health Insurance Program, or SCHIP, as well as Medicaid. Known as Medi-Cal in California, Medicaid provides coverage for the poor. SCHIP is called Healthy Families in California, and serves children in low- to moderate-income working families.
Expanding the programs could help people like 5-year-old Kayla Cervantes of East Los Angeles, a second-generation Californian who has had no health insurance for about half of her life. Her parents make too much money to qualify for insurance through SCHIP and other government programs, but not enough to afford private coverage.
Their backup plan if Kayla gets sick is to take her to a doctor in Mexico, where they have relatives.
