Sen. Jay Rockefeller (D-W.Va.) (Photo by Mark Murrmann/ZUMA Press)

The Democrats’ proposal to terminate the Children’s Health Insurance Program would hike health care costs for some of the country’s low-income families, likely increasing the number of uninsured kids in the name of expanding coverage, several health policy experts and state health officials warned Friday.

Under the sweeping health reform bill passed by House Democrats last weekend, CHIP would cease to exist at the end of 2013, instead shuffling those kids into Medicaid or private insurance plans on a proposed insurance marketplace, called the exchange.

Image by: Matt Mahurin

Stan Dorn, senior health policy researcher at the Urban Institute, said there are certain advantages to scrapping CHIP. Both Medicaid and exchange plans, for example, would never require congressionalreauthorization — a process CHIP is subjected to every few years, he pointed out. But due to CHIP’s affordability, Dorn said “it’s clear” that kids “are much better off” under CHIP than they would be under private exchange plans.

“It’s not even a close question,” Dorn said during a children’s health care forum on Capitol Hill Friday.

Studies suggest Dorn’s concerns are valid. One analysis, conducted by Watson Wyatt Worldwide, an actuarial research firm, found that families living between 175 and 225 percent of the federal poverty level pay just 2 percent or less of treatment costs under CHIP. Under the proposed exchange plans, researchers found, those same families would pay up to 35 percent of their children’s health costs.

Nate Checketts, director of Utah’s CHIP program, noted that the move to more expensive exchange plans would only discourage low-income families already pinching pennies in the economic downturn. “Unless there’s a mandate, I don’t think those low-income families will sign up for it,” saidChecketts.

CHIP was created in 1997 with broad bipartisan support and renewed for five additional years last February. The popular program is designed to cover children in low-income families that are ineligible for Medicaid. The House bill would both expand Medicaid and dismantle CHIP, sending some kids currently covered under the program into Medicaid plans and others into private plans on the exchange.

The Senate Finance Committee also initially proposed to terminate CHIP when it unveiled its legislation in September. However, the committee last month approved an amendment, sponsored by Sen. Jay Rockefeller (D-W.Va.), to reauthorize the program through 2019.

Supporters of the House proposal argue the advantages of centralizing control over CHIP coverage. Because CHIP is managed by states, there is a fear among some lawmakers that lean economic times could lead to sharp CHIP cuts in some spots, leaving those kids without any coverage at all. Those fears were almost realized earlier this year when California, facing a severe budget squeeze, temporarily froze new CHIP enrollment. Some health policy experts have pointed out that it’s probably not a coincidence that many House Democrats pushing the CHIP repeal are from California, including Speaker NancyPelosi, Rep. George Miller, who chairs the Education and Labor Committee, and Rep. Pete Stark, who heads the Ways and Means health subpanel.

Rep. John Dingell (D-Mich.) has also defended the plan to terminate CHIP, arguing in a recent email that “enrollment of kids increases when the entire family can be enrolled under one plan.”

Checketts agrees, pointing out the difficulties that can arise when family members’ health coverage is scattered across different programs. “It is a good goal,” he said, “to get families on a single source of coverage.”

Yet some analysts have concluded that affordability is the more significant factor to ensuring coverage.

The advantages of providing families with low-cost access to health coverage for their kids, Dorn said, “significantly outweighs the benefits of putting parents and kids in the same health plan.”

Other children’s health care advocates are agnostic. Jocelyn Guyer, co-executive director at Georgetown University’s Center for Children and Families, said Friday that, while CHIP has proven “a great success,” getting affordable coverage for kids is more important than what program provides it.

Ron Pollack, executive director of Families USA, a consumer health care group, also indicated that affordability is more critical for ensuring children have health insurance. “What are the out-of-pocket costs, and what is the care that they’ll receive?” Pollack asked, without endorsing either the House or Senate approach to CHIP.

If an analysis by the Congressional Budget Office is correct, the Senate’s plan to salvage CHIP is the more affordable option. Examining the Senate Finance Committee’s initial proposal to repeal CHIP, CBO Director Douglas Elmendorf noted last month that “some of those children would be eligible for subsidized coverage in the exchanges but would not be enrolled in an exchange plan.”

The reason, Elemndorf explained, is “at least in part to the higher premiums and higher out-of-pocket costs that they would typically face in such a plan.”

The truth is a little murkier than that. The man was a supporter of fringe Democratic activist Lyndon LaRouche, whose LaRouchePAC has been running with the “Obama=Hitler” theme for a few months now. That “I’ve Changed” poster seen at the rally can be downloaded as a PDF from LaRouche’s Website.

Conservative blogger Stephen Gutowksi pointed out the LaRouche connection in a video linked by BlogProf, the Michigan conservative who questioned the Dingell event.

What’s this mean? It’s really not good for conservative opponents of Democratic health care reform plans when their fellow activists are pictured with signs comparing the president to Hitler or accused of painting swastikas on congressional offices. The solution: Blame these incidents on “plants” or call them hoaxes. If they want to know how hard this will be, though, they should ask the anti-Iraq War protesters who watched coverage of their events focus on the craziest, fringiest people there. The LaRouche cultists are not “plants.” They want, sadly, to be allies.

The Washington Post describes the bill as lending the FDA “broad new enforcement tools, including the authority to recall tainted food, the ability to ‘quarantine’ suspect food, and the power to impose civil penalties and increased criminal sanctions on violators.”

Among other things, the proposal would put greater responsibility on growers, manufacturers and food handlers by requiring them to identify contamination risks, document the steps they take to prevent them and provide those records to federal regulators. The legislation also would allow the FDA to require private laboratories used by food manufacturers to report the detection of pathogens in food products directly to the government.

Just one question: Why doesn’t FDA have these powers already?

It was no mystery that Rep. Henry Waxman (D-Cal.) was intent on making environment-friendly changes when he swept the chairmanship of the powerful House Energy and Commerce Committee from beneath auto-friendly Rep. John Dingell (D-Mich.) in November. And this week, that house-cleaning began in earnest.

In a reshuffling that will remove several Dingell allies from key environmentally sensitive posts, Waxman melded two E&C subcommittees — the Energy & Air Quality panel and the Environment & Hazardous Materials panel — to form the Energy and Environment subcommittee, of which Rep. Edward Markey (D-Mass.) will be the chairman, the Boston Globe reported today.

Markey, who also heads the House committee on energy independence and global warming, has long been among the most fervent congressional environmentalists, pushing for increased fuel efficiency standards and protection of the Alaska’s Arctic National Wildlife Refuge, among a long list of pet causes.

Displaced in Waxman’s reorganization will be Rep. Rick Boucher, a Virginia Democrat who has long protected the interests of Big Coal. Boucher, who heads the soon-to-be-disbanded Energy and Air Quality Subcommittee, will instead take control of the Subcommittee on Telecommunications and the Internet, a post currently held by Markey. Rep. Gene Green (D-Tex.), another Dingell ally who now heads the soon-to-be-extinct Environment & Hazardous Materials panel, is apparently out of a chairmanship.

Grist writer David Roberts has a nice wrap-up today of the implications of all this reshuffling:

This gives Markey a one-two punch: he can craft and help pass climate/energy legislation through the Subcommittee while using the Select Committee to educate other committee chairs about how the issue affects their jurisdictions. I can’t think of another committee chair who has the same kind of megaphone with which to drum up support for his own legislation, in the House and among the public.

With this move, Pelosi’s House further cements itself as the likely force for boldness on climate/energy issues in coming years. The Speaker is by all accounts a sincere and committed greenie. She has Waxman at the helm of the relevant committee. She has Markey running the relevant subcommittee and doing education/advocacy. Dingell and his allies — the go-slow lobby — have been cleared away. All systems are go.

Towns had angered Pelosi a few years back for voting with Republicans on a controversial trade bill (it passed by two votes) and disappearing during an important vote on the GOP budget (it also passed by two votes). As retaliation, she’d threatened to remove Towns from his post on the energy and commerce panel. With yesterday’s appointment, it looks like the Speaker has tempered that grudge.

In a Nov. 21 letter to Waxman, who defeated Dingell for the E&C chairmanship yesterday, House Minority Leader John Boehner (R-Ohio) urged the California liberal not to use his new powers to push legislation allowing his home state to set stricter vehicle emissions standards. California, along with more than a dozen other states, has submitted a waiver with the Environmental Protection Agency to install new allowances. The waiver, which would cut emissions 30 percent by 2016, was denied by the Bush administration. Dingell is also a fierce opponent.

Boehner, in his letter, outlines the reason that the automakers and their Washington supporters disapprove.

“This change would effectively bar the American auto manufacturers from competing in the largest market in America,” Boehner wrote, “unless they make substantial changes in manufacturing that would increase costs to consumers, making the “Big 3″ even less competitive — and making their collapse even more likely.”

There are several holes in that argument. First, the states currently waiting in line to adopt new standards sell 45 percent of the nation’s vehicles, meaning the change would force the automakers either to produce two sets of cars, or make California’s plan the national model. Daniel Becker, directer of the Safe Climate Campaign, said approval of the waivers would create “a de facto national standard.”

Second, many experts attribute the industry’s current troubles to a failure of the Big Three to produce the smaller, cleaner, more fuel-efficient cars that Americans want to buy. The very manufacturing changes Boehner suggests will kill the industry, these observers say, are actually its only lifeline. Lawmakers like Dingell who have resisted these reforms in the name of helping the industry, they add, have really just protected it to death.

David Jenkins, director of Republicans for Environmental Protection, said GOP leaders like Boehner should be careful not to go after Waxman and others who would push environmental reforms supported by the public. “That would be a big mistake,” Jenkins said. “If the party gets on the wrong side of that [the environmental debate], they’ll be on the wrong side of history — and they’ll be out of power for a long time.”

The debate might be unnecessary. President-elect Barack Obama, who also supports the California waiver, will have the power (through the EPA) to approve it without any congressional action. Indeed, he has already vowed to do just that.

The select committee, headed by Rep. Edward Markey (D-Mass.), was seen as a conduit for Democrats to get some of their more ambitious energy plans around Rep. John Dingell (D-Mich), whose defense of Detroit’s automakers have led him to oppose some of the central items on his party’s energy-reform wishlist. Dingell, who served as the Democrats’ top figure on the Energy and Commerce Committee since 1981, is a long-time obstructionist of tighter emissions allowances and vehicle-mileage standards.

In the wake of yesterday’s vote replacing Dingell with Rep. Henry Waxman (D-Cal.) atop the E&C panel, there was some question whether Markey’s panel would be necessary any longer. Pelosi answered the question Friday. From The Hill:

“We do have a need for one more term, because our work is not done,” Pelosi said at her weekly press conference with reporters. “We do not have the climate change legislation that I had hoped we might be closer to, at least at this point.”

Rep. Henry Waxman (D-Calif.) (WDCpix)

In Capitol Hill’s Rayburn office building, in the private chambers of the House Energy and Commerce Committee, hangs an enormous satellite photograph of the planet earth. Beneath the picture is a couch, where, according to sources familiar with the committee, long-time Chairman John Dingell is fond of sitting. From that couch, they say, the venerable Michigan Democrat, who has served for 53 years, has been known to point up to the photo and say, “That is the jurisdiction of this committee.”

Now, Dingell is no longer in control of the world.

Illustration by: Matt Mahurin

House Democrats Thursday morning took the remarkable step of ousting Congress’s longest-serving member as head of the powerful energy panel. They replaced Dingell with the more liberal Rep. Henry Waxman (D-Calif.), whose energy plans are more in-line with those of President-elect Barack Obama.

The vote — 137 to 122 — marked a stunning defeat for the party’s seniority system.

Environmentalists, though, are thrilled. For decades, Dingell has fought successfully against efforts to adopt stricter emissions rules and force Detroit’s automakers in the direction of greater fuel-efficiency. With the arrival of an Obama administration next year, many climate-change groups had wondered how the new president would sneak his ambitious energy plans past the powerful head of the energy panel. Now he won’t have to. Waxman, a fiery environmentalist who has butted heads with Dingell on these issues, is seen to symbolize the end of Dingell’s obstructionism.

“It’s a whole new world,” said Daniel Becker, director of the Safe Climate Campaign, a group formed to fight climate change. “We can now redirect our global-warming policies in ways that otherwise weren’t possible.”

Speaking to reporters after the vote, Waxman said the Congress has “an opportunity that maybe comes only once in a generation,” and that Democrats “needed a change” in energy committee leadership if the party’s climate change goals are to be accomplished. Seniority, he added, must sometimes give way to party goals.

“We are at a unique moment in history,” Waxman said. “Seniority is important, but it should not be a grant of property rights to be chairman for three decades or more.”

Dingell has been either chairman or ranking member of the panel for the past 28 years. In a short statement, he congratulated Waxman, vowing “to work closely” with the new chairman on issues particular to the panel. In a symbolic gesture, House Speaker Nancy Pelosi (D-Calif.) made Dingell the panel’s chairman emeritus.

The struggle between the two legendary Democrats has captivated post-election Washington, but the significance of the power shift, environmentalists say, will extend far beyond the nation’s capital.

“The committee can move much further under Waxman than it ever could under Dingell,” said David Jenkins, director of Republicans for Environmental Protection. “[Dingell] wasn’t willing to go where we needed to go, and obviously, that was why he was challenged — and why he lost.”

While both Dingell and Waxman have introduced bills to tackle global warming, “Waxman will want to take the fight further and faster than Mr. Dingell would,” said Becker, who formerly headed the Sierra Club’s global warming division.

Indeed, Dingell’s proposal would reduce emissions 80 percent below 2005 levels by 2050. Under Waxman’s plan, 2050 emissions would be cut 80 percent below 1990 levels — the same plan pushed by Obama.

Waxman and Obama are also on the same page when it comes to creation of a “cap-and-trade” system to regulate emissions. Both want to force all large polluters to pay for every ton of carbon emitted. The energy industry, including coal-generating power plants, have fought these strict measures. Protecting the industry, Dingell has floated plans that would give companies some of these pollution credits for free.

Then there’s the enormous issue of fuel-efficiency. In the name of protecting Detroit, Dingell has fought with Pelosi, Waxman and other Democrats over efforts to force U.S. automakers to hike their fleets’ mileage standards. Over Dingell’s objections, Congress passed a bill hiking those standards to 35 miles-per-gallon by 2020. But many Democrats, including Obama, would like to see that figure set substantially higher.

Also significant, Dingell has been a strong ally of Rep. Rick Boucher (D), the Virginia Democrat who heads the energy panel’s Energy and Air Quality Subcommittee. Both Boucher, who represents Virginia’s coal country, and Dingell have been fierce defenders of the coal industry — considered the leading cause of global warming. With Waxman at the helm of the committee, Boucher’s role over energy could be diminished.

The Energy and Commerce Committee also holds great sway over health-care policy — another of Obama’s priorities in 2009. Both Dingell and Waxman have been fierce proponents of providing coverage to all Americans, particularly children.

Waxman said he hasn’t decided what issue he’ll approach first. “The first thing I had to tackle was this contest,” he said.

As an end-run around Dingell, Pelosi created a special panel last year designed specifically to tackle climate change. Rep. Edward Markey (D-Mass.), another ardent environmentalist, heads that committee. It’s too early to tell how the climate change committee will interact with Waxman’s energy panel.

Markey’s office did not respond to calls for comment.

Dingell’s loss is another blow in what has been a difficult week for America’s automakers. Executives for the Big Three have lobbied tirelessly on Capitol Hill for $25 billion in emergency aid, but Democratic congressional supporters lack the backing to get the bill through the Senate. Democratic leaders said Thursday that they could return to Washington in December to consider a bill — but neither the White House nor Senate Republicans have shown much willingness to bend.

Democrats, including Obama, have vowed to take up the Detroit bailout in January if Congress fails to act on it this year. With Waxman at the helm of the energy panel, that might be just one of the many priorities the party tackles in 2009.

“We have a unique opportunity,” Waxman said. “We may well turn out to be as historical as the Congress was in 1933.”

Dingell, who’s represented Dearborn, Mich., for 27 terms, has been a long-time defender of Detroit’s automakers — a force who’s been a thorn in the side of environmentalists who have pushed for stricter emissions standards and more efficient American cars. Waxman has long-sided with the environmentalists on those issues, and is seen as more closely aligned with President-elect Barack Obama’s ambitious energy wishlist.

Later today, we’ll have a piece detailing the significance of Waxman’s victory.

Tomorrow, the entire House Democratic caucus will vote to decide the ultimate winner.

A great deal hinges on the outcome. Dingell, the longest-serving member of Congress, has close ties to Detroit’s automakers. For decades he’s led efforts to thwart the plans of some other Democrats to limit tailpipe emissions and raise fuel-efficiency standards. Waxman, just elected to his 18th term, has long advocated for these changes. With an Obama administration set to take the White House in January, environmentalists are drooling at the thought that the liberal Californian could be the gatekeeper to many of Obama’s ambitious green-energy plans — which would have to pass through the Energy and Commerce Committee.

There are no forgone conclusions. Dingell is monolith with enormous sway over his colleagues. But Waxman, as today’s vote proves, is no slacker when it comes to whipping support. Indeed, he’s won contests against seniority before.