The fate of the Affordable Care Act may be deeply divisive, but there's one aspect of the health care system that retains broad support across the political spectrum — the Children's Health Insurance Program. Created in 1997 from the ashes of President Bill Clinton's failed health care reform plan, it provides health insurance coverage for about 9 million children nationwide whose families make too much to qualify for traditional Medicaid but not enough to afford health insurance on their own. Its impacts have been far reaching; a 2014 Kaiser Family Foundation report summarized the research on its effectiveness, finding "strong evidence" that the program expanded the number of children who had coverage, increased the quality of the care they received, strengthened low-income families' finances and even bolstered student performance based on improvements to children's health.
But Congress is so screwed up that, as of last weekend, it allowed the program to expire. A bipartisan deal was in the works in the Senate, but Republicans in both chambers got distracted by yet another attempt to repeal the Affordable Care Act, and the deadline to re-authorize funding for CHIP passed on Saturday.
That doesn't mean all 9 million children lose health insurance right away. The program is administered by the states, and they generally have leftover funds from previous years. A few locales are expected to run out of money quickly — locally, Washington, D.C., is in that category — but most will be able to keep their programs going into the next calendar year. Maryland, which has about 140,000 CHIP enrollees, has enough money to last through March, state officials estimate.
Consequently, some Republicans in Congress have downplayed the urgency of the situation, saying they will be able to act before kids start getting kicked off of coverage. That may not be true in every state — Minnesota officials report that their funding situation is already dire, and they aren't alone — and there's no reason for confidence that Congress will actually get its act together in time. Though CHIP in general is popular, there are details enough in the reauthorization to trip up this Congress.
The Senate CHIP bill, negotiated by Republican Sen. Orrin Hatch (one of the co-creators of the program, along with the late Sen. Edward Kennedy) and Democratic Sen. Ron Wyden, calls for the program to be renewed for five years, not the two-year extension that some conservatives favor. Also at issue are enhanced federal subsidies baked into the Affordable Care Act. That law bumped the federal contribution for CHIP by 23 percentage points (bringing it to 100 percent in some poor states), and, as with all things Obamacare, some congressional Republicans want the extra subsidies to end immediately. The Hatch-Wyden bill would phase them out over the five years, but that may not be good enough to satisfy conservatives. And then there's the overall issue of where the money would come from; CHIP costs the federal government about $17 billion a year, and the legislation includes no details about how that would be offset.
In some states, where CHIP operates autonomously from Medicaid, the program could be shut down completely as soon as the federal funds run out; Arizona actually has a law requiring it. Maryland's program is structured differently, and the state would not be allowed under federal Medicaid maintenance of effort rules to kick kids out of the program without federal approval. But it would take a big financial hit. Currently, the federal government picks up 88 percent of the cost of CHIP in Maryland, and if funding runs out, that would drop to 50 percent, costing the state about $160 million a year.
A House committee is scheduled to hold a hearing on renewing CHIP tomorrow, and advocates were cheered to learn today that the bill it will consider is in the same posture as the Senate's in terms of the five-year reauthorization and gradual wind-down of the enhanced subsidy. But the House hasn't figured out how to pay for it yet either, and particularly in that chamber, an agreement by the leadership has been no guarantee recently of ultimate success.
There's not much time. In addition to Minnesota, several other states are expected to start on Nov. 1 to send families notice that the program will end. At the very least, that means anxiety and confusion for families that could entirely have been avoided if Congress had simply done its job before Oct. 1. At worst, children will start losing health insurance coverage, and states like Maryland will be on the hook for hundreds of millions in extra costs. Congress needs to correct its mistake and send a CHIP reauthorization to the president immediately.