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Congress must act to preserve CHIP and protect America's children

Congress must act soon to preserve the CHIP program.
Congress must act soon to preserve the CHIP program. (Jack Ohman)

On any given day we see dozens of children and adolescents at the Harriet Lane Clinic, part of the Johns Hopkins Children's Center located in the heart of Baltimore City. The kids come in from around the city for a variety of services — anything from a vaccine to comprehensive care for complex health conditions. We are their primary care provider and, for most, their only source of health care. Over 90 percent of our patients have access to this care because of Medicaid and the Children's Health Insurance Program (CHIP). Despite last week's Senate Finance Committee decision to extend federal funding of CHIP for five more years, the program is still in limbo as we wait for the House to address its looming expiration on Sept. 30.

Health coverage for about 131,000 children from low-income families in Illinois could be in jeopardy if Congress doesn’t act soon to renew a program.

Many of the kids I see at our clinic are already fighting an uphill battle against unhealthful environments of poverty, violence and persistent racial, ethnic and socioeconomic health disparities. Some come from homes where parents are working long hours in minimum wage jobs to make ends meet or in unstable homes with parents who have health problems. They experience "toxic stress" at an early age, which jeopardizes their short- and long-term health.

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Critical in reversing some of these negative health trends and combating these disparities is reliable health care coverage. Ninety-five percent of U.S. children have health insurance. Medicaid is the single largest insurer of children, covering 30 million nationwide. CHIP protects nearly 9 million children in the U.S. whose families make too much to qualify for Medicaid but not enough to afford private insurance. In Maryland alone, approximately 140,000 children were enrolled in CHIP in fiscal 2015. These children must have access to quality health care, and CHIP is essential to this.

Medicaid represents the single largest source of federal funding to our state. Loss of that funding because of federal caps, block grants and cuts would shift costs back to the state.

In the U.S. and states such as Maryland, we have the most advanced technology and understanding of disease in the world, and we have the capacity to help ailing kids. At Johns Hopkins, we can diagnose and cure children with dangerous diseases such as cancer or extensively drug-resistant tuberculosis. Insurance is needed to see multiple experts, maintain expensive drug regimens and do all of the necessary follow-up.

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Cutting funding for CHIP would make it impossible to care for patients like this. It would be the quickest route imaginable to increasing the numbers of unhealthy, struggling children in our country. And while health care costs continue to be a concern of Congress, children are not the cost driver. They are 43 percent of Medicaid enrollees but only 19 percent of Medicaid spending.

Within the larger health care debate is the question of the future health of the nation. 

Children are our country's biggest asset. They must grow up healthy to support our future economy. As Congress considers its approach to health care reform, at stake is the health of the 30 million children who rely on Medicaid and the 9 million who rely on CHIP. They are our country's future workforce and long-term economic sustainability. We cannot afford to jeopardize their health.

As a pediatrician, I am trained to talk to my patients about avoiding smoking, drugs, alcohol and risky sex. Implicit in this is the notion that my patient believes in and has hope for a positive future.

How can we expect children to have hope for their future if they don't have access to basic needs such as medical care? What happens to the children who need it most? We must protect our children and our future. Congress needs to take action now and reauthorize federal funding of CHIP and maintain Medicaid coverage. Our children are watching.

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Dr. Tina Lee Cheng (tcheng2@jhmi.edu) is the Given Foundation professor of pediatrics, director of the Department of Pediatrics for the Johns Hopkins University School of Medicine with joint appointment in the Johns Hopkins Bloomberg School of Public Health and pediatrician-in-chief of The Johns Hopkins Hospital.

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