CHIP Works: Will Congress Protect It For Millions of Children?
Bruce Lesley, State Policy Advocacy and Reform CenterHealth
This blog post originally appeared in Huffington Post.
In 1991, the bipartisan National Commission on Children called for action on increasing health insurance coverage to our nation’s children and pregnant women. As they found:
Good health is essential to children’s growth and development and in their future prospects. While most American children are born and remain healthy, far too many are vulnerable to problems that lead to serious illness, disability, and even death. This country has the knowledge and the tools to save children’s lives and improve their physical and mental health.
Six years later, bipartisan efforts in both the Senate and House of Representatives led to the passage of the Children’s Health Insurance Program (CHIP) as part of the Balanced Budget Act (BBA) of 1997. The bill signed into law by President Bill Clinton on August 5, 1997.
In contrast to Medicaid, which was designed to generally serve the nation’s poorest children and pregnant women, CHIP picks up where a state has designed its Medicaid eligibility level to end. States have great control and flexibility over the design and administration of CHIP. And, over time, states have learned what works, what doesn’t, and have modified their programs, in partnership with private health plans, to constantly improve the health coverage to children.
By Any Measure, CHIP Has Been a National Success Story
So, seventeen years later, how has CHIP fared?
First and foremost, as a federal-state and public-private health care partnership, CHIP is an American success story that last year provided health coverage to 8.4 million children across the country.
According to the U.S. Centers for Disease Control and Prevention, since CHIP was established, the uninsured rate for children has been successfully cut by more than half – from 13.9 percent in 1997 to 6.6 percent in 2012.
And, in a congressionally mandated evaluation of the program by Mathematica Policy Research and the Urban Institute that was released this past August, the authors conclude:
CHIP succeeded in expanding health insurance coverage to the population it is intended to serve, particularly children who would otherwise be uninsured, increasing their access to needed health care, and reducing the financial burdens and stress on families associated with meeting children’s health care needs.
Simply put, CHIP works.
Families whose children are covered by CHIP also report that it works well. For example, in a 2014 Satisfaction Survey of Iowa parents whose children were enrolled in “hawk-i” (Iowa’s CHIP program), an astounding 93.7 percent expressed satisfaction with the care received and less than 1 percent (or 0.7 percent) expressed dissatisfaction with the care their children received.
One major reason is that CHIP recognizes that children are not little adults and that they have unique developmental needs. Consequently, CHIP is, by definition, dedicated to delivering health care benefits and services that addresses the special health care needs of children. Unlike other health coverage, CHIP provider networks are, by definition, pediatric-centered and quality measures are exclusively focused on child development, outcomes, and child well-being.
As Dr. James Perrin, president of the American Academy of Pediatrics, writes:
CHIP is a bipartisan program that works for children. During this time of reform in health systems across the country, CHIP offers what many plans in the private marketplace may not yet provide: benefits specifically designed for children, affordable options for families, and networks of pediatricians and pediatric subspecialists who provide critical services and expertise designed to address children’s unique needs.
Unfortunately, although CHIP funding is not scheduled to expire until the end of September 2015, there is urgency to extend CHIP funding as soon as possible. States are already putting together their budgets, negotiating contracts with health plans, and those health plans are, in turn, putting together their pediatric provider networks for FY 2016.
Governors, Advocates, the American People, and the Evidence Support CHIP
CHIP is administered at the state level and both Democratic and Republican governors fully recognize its great value to the children in their states. In fact, 39 out of 39 governors – a majority of which are Republicans – have written in support of CHIP and have urged Congress to pass legislation to extend CHIP funding as soon as possible. Every single governor highlights the fact that CHIP provides stronger coverage to children than all possible alternatives. As a summary of the governors’ letters by leaders of the United States Senate Finance and House Energy and Commerce Committees explains:
Governors reported that CHIP is more affordable to consumers than exchange or employer-sponsored coverage and generally has a richer benefit package. All 34 governors that mentioned the cost of care to consumers indicated that CHIP coverage is more affordable than private coverage, such as that offered on the exchanges or by employers.
This is one of the reasons why over 1,200 organizations, representing every state across the country, have highlighted how vital CHIP is to millions of children and are asking Congress to extend CHIP funding as quickly as possible.
That letter cites an independent study by Wakely Consulting Group, which confirms that – in terms of pediatric benefits, affordability, and pediatric networks – CHIP is far superior coverage to what children would receive if they were moved to coverage through the marketplaces in the Affordable Care Act. Moreover, due to the “family glitch,” an estimated 2 million children would not be able to transition from CHIP to the marketplace plans and would lose coverage altogether if CHIP were allowed to expire.
In addition to advocates and our nation’s governors, American voters also strongly support extending and renewing CHIP by a wide margin (74-14 percent in a May 2014 poll by American Viewpoint).
And finally, the Medicaid and CHIP Payment and Access Commission (MACPAC), a non-partisan agency created by Congress to make policy recommendations to Congress, the Secretary of Health and Human Services (HHS), and the states on a wide range of issues related to Medicaid and CHIP, also recommends that CHIP be extended.
In testimony before the U.S. House Energy and Commerce Committee, Anne Schwartz, MACPAC’s Executive Director, warns that if CHIP were to expire:
Many of those affected children would become uninsured or face significantly higher cost sharing and potentially different benefits and provider networks in the exchange.
Failing to Extend CHIP Would Be Nonsensical
Having heard a near unanimous chorus of approval from the nation’s governors, doctors, nurses, hospitals, child advocates, the public, independent outside studies, and its own agencies (MACPAC, the Government Accountability Office, and the Congressional Research Service) that CHIP is successful and works very well for children, one might think Members of Congress would be rushing to embrace the extension of CHIP, particularly since they have a congressional job approval ratingthat is at just 13-14 percent.
The fact is, for political leaders in both parties, failing to support and protect CHIP would make no sense at all.
For Republicans, CHIP was initially created by a Republican-controlled Congress and the evidence clearly shows that it has been implemented in a successful manner by a number of Republican governors across the country. CHIP is also appealing to Republicans because it is a proven public-private partnership that offers effective coverage to children in working families at the lowest cost and a block grant that gives states great flexibility.
In addition, since CHIP is not Obamacare, CHIP’s extension gives Republicans something to be for that is popular with the public and their own governors. And, with many Republicans promising to continue efforts to repeal Obamacare, it makes no sense whatsoever for a Republican-led Congress to put CHIP at risk because the alternative to CHIP would be either to move millions of children with excellent health coverage into Obamacare or have them lose coverage altogether.
And for Democrats, CHIP was created under President Bill Clinton, extended under President Barack Obama in 2009, and has been implemented in a successful manner by Democratic governors across the country. CHIP has, in partnership with Medicaid, cut the uninsured rate by more than half since its inception and has been a popular achievement as to how public policy can work well for children and families.
Moreover, while Democrats can increasingly point to how Obamacare is making progress on cutting the nation’s uninsured rate, it would make no sense at all to backtrack on the success CHIP has made in cutting the uninsured rate for children across the country.
Clearly, staring Congress in the face is a pathway of continued success. It is a path that governors, advocates, health care providers, and impartial research have all pointed them toward: stay the course, do the right thing, and extend CHIP.
Threats to the Health of Children and Future of CHIP
Unfortunately, there are other forces that are pushing Congress to stall, take perilous alternative paths for kids, or play politics in a manner that threatens CHIP and the health coverage of over 8 million children.
First and foremost, Congress’s modus operandi has slowed to a grinding halt in recent years. And, because children do not vote, do not make political contributions, and do not hire lobbyists, they have a difficult getting much needed attention from Congress. The marginal attention that Congress has shown the 1 in 5 children in this country who are living in poverty or the 2.5 million homeless children in America highlights this problem.
Congress also applies much different rules to children’s programs than other legislation it considers. In fact, Congress often passes legislation that creates an array of tax breaks and loopholes that are not offset and, therefore, increase the federal deficit. This is a federal debt that we are passed on to the next generation to pay off. And yet when it comes to funding for children, it is then that Congress demands legislation be budget neutral and fully offset.
For example, Michael McAuliff reported that the House Ways and Means Committee, during a legislative mark-up earlier this year, objected to passing legislation that “would spend $1 million a year to help keep foster kids out of the sex trade” because the bill was not fully offset but then “voted in favor of $310 billion in tax breaks for businesses” without budget offsets.
Legislation affecting children is also threatened by some in Congress (both members and congressional staff) who like to engage in “hostage taking” of issues, such as CHIP, that are popular with the public. They block action on popular or must pass measures while attempting to extract concessions or action from their colleagues on nominally related and sometimes unpopular pet projects.
Others pay lip-service to the plight of children but don’t actually do much for kids. As an example, former Senator Hank Brown and Barry Jackson, former advisor to Speaker John Boehner, recently wrote an Op-Ed for the Denver Post arguing that:
Earlier this month, voters pressed the ‘reset’ button on their government in Washington. Exit polls showed we were concerned about the economy and whether our kids are going to be better off than we are.
Their reference to concern about the future of children comes from a nationwide exit poll conducted on election day that found nearly half of voters surveyed think that life for their children will be worse than life today and less than one-quarter believe it will be better (48-22 percent).
However, while they are quick to initially mention the interest of the public in children, Brown and Jackson continue with a pretty extensive agenda for Congress to pursue that never mentioned the word “children” again. In fact, their policy agenda has nothing to do with addressing the needs and concerns of children at all. To child advocates, this is a far too familiar situation where politicians and their consultants like to “talk the talk” but so often fail to “walk the walk” when it comes to children.
Another potential challenge for CHIP is that partisans on Capitol Hill sometimes plays politics with children’s issues and purposely delay action on them so as to create a crisis whereby they perceive they might gain politically. In a perverse way, they even seem to like losing so that they can criticize the other side for “failing children.” Unfortunately, although they may be publicly sympathetic for doing the right thing on behalf of kids and earn kudos from child advocates for that support, the children they are professing to protect cannot afford tactics that result in failure.
Therefore, despite the overwhelming evidence and political support for CHIP, a successful extension of the program is far from a certainty because there are forces within Congress that like to engage in a variety of political games and brinksmanship that could easily stall, sidetrack, or derail CHIP.
Call on Congress to Extend CHIP
Fortunately, the American people are increasingly turned off by the political games and increasing partisanship and gridlock in Congress, as is reflected in historically low congressional approval ratings. They are calling for Congress to protect children from harm and to take action, and not just lip-service, in support of our nation’s next generation.
And, when it comes to the health of our nation’s children, there really is a successful, bipartisan, and wildly popular health care plan that works well for kids. All Congress has to do is to stay the course and do what three-quarters of Americans are calling on them to do: extend CHIP.