POLITICS JULY 12, 1999
Everywhere you look nowadays, the experts are writing off Campaign 2000--not because they think the result is preordained, but because they think the result is meaningless. George W. Bush's "compassionate conservatism" is so moderate and tempered, the thinking goes, that it is functionally equivalent to Al Gore's "practical idealism"--or even the more lofty idealism Bill Bradley has been espousing. To the extent that there are some minor differences between the candidates over tax policy and such, the pundits agree, they're small beer--particularly given the reality of balanced budget rules that constrain federal spending and a prosperous economy that everybody seems to agree is best left to run itself.
There's certainly some truth to this view. After all, in Bush we have a Republican--from Texas!--who refuses to hold judges to an abortion litmus test, who spends money on public education, and whose chief economics adviser says he believes in taxing capital.
But it's possible to be well to the left of GOP zealots such as Tom DeLay and still be well to the right of Clintonized Democrats. Indeed, even a cursory look through the governor's record in Texas turns up all sorts of issues for which Bush, confronted with a pressing social problem, relied on market-based rather than state-based solutions, skimped on government spending in order to leave money for bigger tax cuts, or simply chose not to take the initiative at all--in other words, cases in which he acted just as you'd expect an authentic Republican to act.
One particularly telling episode was a legislative battle over implementation of a 1997 federal law called the State Children's Health Insurance Program (s-chip). Under the terms of s-chip, the federal government offers to subsidize health insurance for children whose families make too little money to afford it yet make too much to qualify for Medicaid. Details of how to administer the program are left to the states, which are responsible for a portion of the funding (26 percent in Texas's case), on the theory that less federal control allows states to tailor the program to the particular needs of their different populations.
S-chip addresses a very real problem. For the past few years, the number of children without health insurance has risen steadily. As of 1996, 15 percent of children--more than eleven million kids--lacked coverage, according to the Congressional Budget Office. About half of the uninsured children belong to parents who hold low-paying jobs that lack benefits--in other words, just the kind of hard-working, responsible souls that both pragmatic liberals and compassionate conservatives can feel good about supporting. That's one big reason the measure has won bipartisan support--its Senate boosters included Democrat Ted Kennedy and Republican Orrin Hatch--despite a total price tag of $40 billion over ten years. Although some states have been slow to take advantage of s-chip, Republican governors in Connecticut, Michigan, New Jersey, and New York have been among those implementing it aggressively.
So you'd think George W. Bush, who spoke so movingly of "prosperity with a purpose" in his campaign announcement speech, would have been on that list, too. Texas, after all, needs this kind of program: when it comes to children without health insurance, it's the second state in the nation both in raw numbers (only California has more total) and in percentage of the population (Arizona is first). Moreover, Texas is flush with resources to spend on s-chip: just as the program went into effect, Texas had a $2 billion budget surplus to play with, not to mention $1.8 billion from the settlement of the tobacco class-action case.
But, when s-chip became law in 1997, Bush didn't rush to draw up a plan for implementation--the prerequisite for receiving federal support. Rather, he held off submitting a plan to Washington until the Texas legislature could devise one of its own. When the legislature, which meets every other year, did reconvene, Bush proclaimed that "Texas must be a place with healthy children"--and then proceeded to lowball the program with his opening bid. With s-chip, a state could choose to expand health coverage eligibility for children in families earning as much as 200 percent of the federally established poverty line (or even more, in some circumstances). But Bush asked for funding for families only to 150 percent of that modest income level--a level well below what states such as Michigan and New Jersey were setting, and one that would have left between 175,000 and 250,000 uninsured children ineligible for coverage. Although plenty of money was available, Bush, whose chief legislative priorities at the time included a $2.7 billion tax cut, said he was concerned about whether such broad implementation was fiscally responsible--and had his staff lobby to contain the program's expanse, according to lawmakers involved with the negotiations.
In the end, Bush lost. The legislature voted to provide coverage to children in families living at up to 200 percent of the poverty line, financing the $180 million program with the tobacco settlement money. Bush, presented with a fait accompli, made the best of it. At a signing ceremony, he hailed the bill's supporters for "doing what's right for Texas"--even though it seemed to have passed more in spite of him than because of him. Indeed, Glen Maxey, a Democratic representative from Austin who championed the more aggressive measure, recalls that, after the final vote, Bush approached him on the State House floor and said something to the effect of "I want to congratulate you on your victory on the Child Health Insurance Program. You crammed it down our throats." (A spokesman for the governor says that, while Bush indeed congratulated Maxey, the rest of the quote is "not accurate.")
Because the governor kept a relatively low public profile during the s-chip episode, it's hard to know with certainty why Bush was so hesitant to implement the program. One possibility is that Bush was, as he said, simply concerned about cost--and, specifically, whether the federal money would dry up sooner than expected. It's also possible that Bush was trying to appease right-wingers in the Texas state legislature or that he shared their concern that s-chip amounted to creeping Hillarycare. This was the same essential argument made by hard-line conservative organizations such as the American Conservative Union when s-chip was before Congress. (In a letter to Congress, ACU Chairman David Keene had deplored s-chip because "it injects the Federal Government further into the health care system" and urged an alternative course of tax cuts, less regulation, and medical savings accounts.)
A less flattering theory-put forth, naturally, by Bush's chief critics in Austin-is that Bush's stance on s-chip had more to do with sheer stinginess and presidential posturing. Bush might have feared that aggressively advertising s-chip, as the federal law required, would have incidentally made more low-income people aware that they were eligible for Medicaid. This in turn might have further depleted state funds (Medicaid costs more per patient than s-chip, plus it's an entitlement) and, more important, deprived Bush of a potential campaign boast: namely, that he managed to reduce the Medicaid rolls every year as governor. (During his 1994 campaign against former Texas Governor Ann Richards, he had frequently cited the growing Medicaid rolls as evidence of her inability to crack down on welfare.) Sure enough, during the final negotiations, Bush lobbied hard against having a single, common form for s-chip and Medicaid applications.
What these theories have in common is that they are all consistent with a general aversion to government activism on behalf of the poor and disadvantaged. That's a defensible position, to be sure, but it's hardly the one the Democratic presidential contenders have followed over the years. Gore, for example, was a strong advocate of s-chip within the administration. As a senator, Bradley was a vocal advocate of government-run health care programs for the poor. He's also vowed to make universal health care coverage a presidential campaign theme.
The fight over children's health insurance in Texas, then, offers a key insight into what a Bush presidency would really be like. Come 2001, the president of the United States might face a situation quite similar to the one the governor of Texas faced in 1998: a government with a big budget surplus but confronted with pressing social problems. If the s-chip episode is at all indicative, Bush is apt to act as most Republicans would in that situation--that is, he'd put his energies into giving the surplus back to the people as tax breaks rather than strengthening the social safety net and using government to solve problems like the growing ranks of the uninsured. That may or may not be the compassionate thing to do. It is, however, definitely the conservative thing to do. Maybe it does matter who wins this election after all.
This article originally ran in the July 12, 1999, issue of the magazine.