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Contact: Ed Walz
Phone: (202) 657-0685

Brief: CHIP Success a Model for ACA State-Federal Partnerships

Washington – A new brief released today by the bipartisan children’s advocacy organization First Focus identifies important similarities between implementation of the bipartisan Children’s Health Insurance Program (CHIP) and implementation of the Affordable Care Act (ACA). Successfully Navigating the CHIP State-Federal Relationship and Challenges to State Implementation was authored for First Focus by Eugene Lewit, a Consulting Professor of Health Research and Policy at Stanford University. Lewit finds that states overcame initial political resistance to CHIP implementation, resulting in significant coverage gains for children. The author finds important similarities to the ACA, suggesting the potential for states initially lagging on ACA implementation to recover lost ground as political resistance abates.

“Like the ACA, CHIP had to contend with political friction in some states,” said First Focus President Bruce Lesley. “But CHIP’s success story shows that initial resistance can be overcome, resulting in real gains for children and families.”

The analysis focuses on CHIP implementation in Virginia and Texas. In both cases, initial resistance by the states’ governors delayed effective CHIP implementation. But in Virginia, the election of a new governor cleared the way for slow but steady progress covering uninsured children. And in Texas, initial resistance was overcome by a confluence of factors, including the presidential aspirations of then-Governor George W. Bush, gains on covering uninsured children in neighboring states, and the prospect of forfeiting federal funding. Lewit finds that Texas officials compensated for a late start by adopting an aggressive set of improvements, resulting in rapid coverage gains for children.

The brief also observes that federal agency policies and practices can minimize implementation resistance. Specific practices and policies include:

  • Using the rulemaking and review process to maximize the implementation flexibility for states;
  • Uplifting implementation success stories, as a way to encourage friendly competition among states to effectively implement the new initiative; and
  • Cultivating open lines of communication with state governments, including inviting the assistance and facilitation of philanthropic partners as neutral conveners.

“CHIP’s history shows that implementation resistance has as much to do with the politics of state leaders as it does with the federal initiative itself,” said Lesley. “But it also shows that federal agencies can do a lot to minimize that resistance.”