Children’s Coverage Moving Forward: CHIP Must Be Funded Until Comparable Coverage is Assured


iStock_000012699696MediumOn April 16, 2015, the President signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (H.R. 2) (P.L. 114-110), legislation to permanently repeal the flawed formula used to determine Medicare physician payment rates. Most notable for children, MACRA also provides two more years of funding for the Children’s Health Insurance Program (CHIP), which was set to expire in the fall. Click here to see a summary of the key provisions of MACRA for children. This is excellent news for the 8 million children who rely on CHIP for their healthcare, as well as for states that were facing very difficult decisions on enrollment and benefit cuts if CHIP funds were not renewed.

What does the CHIP extension mean for the future of children’s coverage? It means that during this short respite before we face the next CHIP funding deadline we must continue our advocacy to make sure that policymakers understand the coverage needs of children and the unique role CHIP plays in protecting the health and well-being of children in low-income working families.

With MACRA now behind us, child health advocates will press forward with our work to ensure that affordable, high quality, pediatric-appropriate coverage is available to all children no matter the coverage source – whether CHIP, Medicaid, employer-sponsored coverage or Marketplace coverage. While the bipartisan vote in support of MACRA’s CHIP extension provides some hope about the future of children’s coverage, we must not kid ourselves. Given the current climate on Capitol Hill, no matter the work we do in the next two years, it will be extremely difficult to get Congress will to take up “fixes” to the Affordable Care Act (ACA) that would address the so-called “family glitch” and extend CHIP’s protections on affordability, child-specific benefits, and network adequacy to Marketplace plans.

The best health policy minds are already thinking about the future of children’s coverage. Last June, the Medicaid and CHIP Payment and Access Commission (MACPAC) weighed in on the future of CHIP in its June 2014 report when it recommended a two-year CHIP extension. We share MACPAC’s view that there are key issues regarding the affordability and adequacy of coverage that must be addressed before transitioning children from CHIP to other sources of coverage. While MACPAC says it is “confident that the changes necessary to ensure that children have access to high-quality coverage” are doable in the next two years, those of us who work in the advocacy space are more dubious about Congress’ ability to enact the changes needed to prevent children from facing increased costs, fewer benefits or becoming uninsured altogether.

The Bipartisan Policy Center (BPC) shared a similar perspective in its March 2015 report, which also recommended a two-year CHIP extension. Like MACPAC, the BPC also recognized that there is work to do before private coverage can take the place of CHIP. The BPC called for ACA fixes to address gaps in coverage including the “family glitch” and other changes to ensure that low-income children do not face “differences in benefits and higher cost-sharing.”

We wholeheartedly agree with MACPAC and the BPC’s assessment of the changes that are necessary to protect children who are currently covered through CHIP. Fixes to affordability, benefits, and networks are a threshold issue. Without them the current children’s coverage system must remain fully in tact.

As we celebrate the CHIP extension and look toward building on the amazing gains in children’s coverage that have been realized over the last two decades we cannot lose sight of the date that brought us to the dance. We must remember that the rate of uninsured children now stands at a record low because of CHIP and Medicaid. Until ACA Marketplace coverage incorporates key protections for children, in terms of affordability, benefits, and provider networks, it is just too soon to turn the page on CHIP.

CHIP must be protected and continued until families can be sure their children will have access to comparable coverage — same affordability, same level of pediatric benefits, same access to children’s hospitals and pediatric specialists  — through another source. To end CHIP any sooner would leave millions of children worse off. Grownups need to make sure this does not happen.

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Want to learn more? First Focus is a bipartisan advocacy organization dedicated to making children and families the priority in federal policy and budget decisions. Read more about our work on child health.

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