Lawmakers are engaged in a precarious back-and-forth over health care funding for nine million children across the United States after letting the program expire last week.
Funding for the Children’s Health Insurance Program, or CHIP, ended on September 30 after Congress allowed the program to expire without renewal. CHIP, which provides low-cost health care coverage to millions of children (and pregnant parents) around the country, has long enjoyed bipartisan support. That’s been crucial to the program’s survival — while CHIP does receive some state funding, the majority of the program’s budget is federally-funded.
But bitter divides over the Affordable Care Act (ACA) have dominated Congress for months, and President Donald Trump has also worked actively to reduce funding for the program. The president’s 2018 budget proposal advocated cutting $1.7 trillion from CHIP and other vital programs, like the Supplemental Nutrition Assistance Program (SNAP) and both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). With Congress waylaid by ACA repeal efforts and the president uninterested in actively pursuing CHIP renewal, the program’s renewal date came and went, with no plan in place.
Now, politicians on both sides of the aisle are working to reinstate funding for CHIP. But that process itself has become controversial, falling victim to wider politicking. On Monday, House Republicans proposed tacking $1 billion in aid for hurricane-stricken Puerto Rico onto a proposal funding CHIP for the next five years. That proposal more generally calls for a number of measures, including raising Medicare rates for higher-income senior Americans as well as redirecting the ACA’s prevention funds, according to the Washington Post.
That hasn’t gone over well with Democrats, who overwhelmingly support the program but don’t want money taken from the ACA or Medicare. On Wednesday, policymakers fought over the Republican proposal, which eventually migrated out of the House Energy and Commerce Committee on a party-line vote of 28 to 23, with Democrats all in opposition. Republicans argue that the bill is more than fair, pointing to the proposal’s hike on Medicare costs as a necessary action.
“Folks that earn a half-million dollars a year and are over 65, they can pay a little bit more for Medicare,” said Rep. Fred Upton (R-MI). “And you know what? If they don’t want to pay, they don’t have to enroll. That’s a choice they will have.”
The House’s bill would have other implications. Namely, it could impact lower-income Medicaid recipients who win the lottery, which is distributed as a lump-sum amount and not counted as long-term income by Medicaid under current rules — something Republicans are pushing for. Democrats, by contrast, are angered by the proposal’s hefty tax cuts, which many lawmakers have deemed unacceptable.
Another proposal to fund CHIP has also cleared a Senate committee, backed by Sens. Orrin Hatch (R-UT) and Ron Wyden (D-OR). That bill would keep CHIP funded for five years, which advocates support. But it’s unclear how lawmakers plan to cover the bill, estimated to cost between $5 billion and $10 billion. It also needs to clear the House — a dubious outcome given ongoing warfare over the ACA.
“[Republican CHIP proposals] will likely mean more delay and possibly no action in Congress until the end of the year as part of an omnibus appropriations bill,” said Rep. Frank Pallone Jr. (D-NJ) on Wednesday.
Democrats have also offered their own proposals. Senate Minority Leader Chuck Schumer (D-NY) is encouraging colleagues to attach CHIP funding to a wider bill stabilizing the ACA, which has yet to be agreed upon.
“[Senate Majority] Leader [Mitch] McConnell should immediately put this bill to the Senate floor for a vote and include much-needed bipartisan provisions to stabilize the markets, lower premiums in 2018, and renew funding for community health centers and numerous other important health provisions that expired over the weekend,” Schumer said Wednesday.
Hatch opposes Schumer’s suggestion, accusing the New York senator of jeopardizing children’s health. CHIP advocates are also wary; fighting over the ACA already allowed the program to expire, a situation that further association with the health care effort is unlikely to change.
That stalemate has left no clear path forward on funding CHIP — leaving millions uninsured.
While politicians spar over funding, the very real consequences of failing to fund CHIP are set to kick in very soon. Passed in 1997, CHIP has helped lower the national percentage of uninsured children from nearly 14 percent to around 4.5 percent by 2015. Numerous states, along with Washington, D.C., are set to exhaust their CHIP funds by next March, which would leave millions of young patients without coverage for routine check-ups, prescriptions, dental and vision care, emergency services, and a number of other vital health care needs. CHIP’s services extend beyond children, allowing states to extend CHIP to cover expecting parents — the current policy of 19 states. Upwards of 37,000 pregnancies are covered by the program, which advocates say is crucial for lower income parents.
More populous states are among those who stand to lose the most if CHIP goes unfunded. In Texas, which is both the most uninsured state in the nation and has the distinction of claiming the highest maternal mortality rate in the developed world, nearly 400,000 people are covered by CHIP. Texas has enough federal funding to keep the program going until February — but after that, officials say, it’s unclear what will happen.
“CHIP is a critical part of the health care safety net in Texas,” wrote Texas Health and Human Services Commission’s chief deputy executive commissioner, Cecile Erwin Young, in September, urging the program’s renewal. “CHIP has a proven track record of success, stemming from its adherence to the fundamental principles of state administrative flexibility, personal responsibility, and innovation aimed at enhancing health outcomes for beneficiaries.”
California is facing a similar problem. With around 800,000 children covered by CHIP, the state is also set to run out of funds if the program isn’t renewed.
“The Children’s Health Insurance Program ensures that 800,000 kids in California get quality care,” wrote Sen. Dianne Feinstein (D) last week on Twitter. “We must fund
The Children’s Health Insurance Program ensures that 800,000 kids in California get quality care. We must fund #CHIP now.
— Sen Dianne Feinstein (@SenFeinstein) September 29, 2017
California is likely to be among those states most immediately impacted by the funding hold-up as the state’s CHIP allotment dwindles. Minnesota is also facing a crisis — the state has already spent its CHIP funds this year. While the Centers for Medicare & Medicaid Services are giving Minnesota $3.6 million in unspent national funds to cover the state’s children, officials are worried about another vulnerable group: the 1,700 pregnant Minnesotans who aren’t eligible for Medicaid but would otherwise be covered by CHIP.
According to the non-partisan Medicaid and CHIP Payment and Access Commission, Arizona, North Carolina, and Washington, D.C., along with the already-dry Minnesota, are all set to deplete their CHIP funds by December.