Do No Harm to the Health Coverage of Millions of Children

Federal Budget
Health

Raising five children, Rep. Markwayne Mullin (R-OK) undoubtedly knows a thing or two about the health care needs of children. In a Today storyrelated to Father’s Day last year that highlighted the decision of the Congressman and his wife to adopt two children after having three of their own, he shared a picture of himself at the hospital with his son, who had suffered a broken wrist. It is clearly the picture of a caring, loving father who would never intentionally put the health of his children at risk.

In a blog entitled “Leaving a Healthy Legacy” that the Congressman wrote last week highlighting Men’s Health Month, he says:

My kids are smaller versions of myself, so teaching them how to be healthy and giving them access to the tools and resources they need to maintain a healthy lifestyle is vital to their growth and development in adulthood.

This month, I encourage you to make a commitment to your own health. Let’s leave a healthy legacy for the next generations of Oklahomans.

In March 2015, Rep. Mullin helped “leave a healthy legacy” when he voted in favor of a bill, the Medicare Access and CHIP Reauthorization Act of 2015, which fixed a problem with the Medicare physician payment formula to address access to care concerns for senior citizens but also extended funding for the Children’s Health Insurance Program (CHIP) for two years. Child advocates from across the country were supportive of the extension of CHIP, even though the two-year extension was shorter than the four years they were seeking.

Mullin also recently expresses great concern about another health policy issue: potential budget cuts that would be “detrimental” to providers in the Medicaid program due to Oklahoma’s difficult budget situation. As he explains in a Tulsa World Op-Ed on May 27, 2016:

This year, falling oil prices and other factors led to state legislators facing a $1.3 billion budget shortfall going into 2017. To make up for the shortfall, the Oklahoma Health Care Authority prepared Oklahoma Medicaid providers for the possibility of a 25 percent rate cut. It doesn’t take a health care expert to understand that a rate cut of this magnitude would be detrimental to Oklahoma’s health care providers.

Luckily, our state Legislature worked to develop a state budget that only cuts Medicaid rates by 3 percent, and while a 3 percent cut will still impact our nursing homes and hospitals, it is not the disaster it could have been.

We would agree with him that enormous cuts to Medicaid would have been devastating to providers. However, we would add that such cuts would have been harmful to hundreds of thousands of people the program, known as SoonerCare, provides coverage to in Oklahoma. According to Oklahoma Watch, nearly two-thirds of those covered by SoonerCare are children.

However, the Congressman clearly distinguishes Medicaid and CHIP from the Accordable Care Act (ACA) or Obamacare, which he has repeatedly voted to repeal. In a Tulsa World Op-Ed, he explained, “All in all, I have supported more than 50 different efforts to either fully repeal or chip away at ‘Obamacare’ since my time representing your family in Congress.”

Although we agree changes need to be made to the ACA, including major revisions to the “family glitch”, the “Cadillac tax”, or other improvements outlined by Georgetown’s Center for Children and Families, we oppose repeal of the law because it would dramatically increase the number of uninsured children and create a number of other negative consequences for America’s children.

In short, when it comes to public policy issues, Rep. Mullin has clearly voted for or expressed interest in: (1) support for CHIP and children’s health coverage; (2) opposition to Medicaid cuts that would create negative consequences for Oklahoma’s health care providers; (3) opposition to Obamacare; and, (4) concern about the Oklahoma’s state budget deficit.

What is surprising, then, is that a recent vote and a bill introduction by Rep. Mullin would have, paradoxically, either the opposite results or unintended negative consequences to those four policy positions.

First, Rep. Mullin, as a member of the House Energy and Commerce Committee, voted in favor of H.R. 4725, the “Common Sense Savings Act of 2016,” which would rollback the Enhanced Federal Matching Assistance Program (E-FMAP) in CHIP by 23 percentage points effective March 16, 2016. For Oklahoma, their federal matching rate this year is 95.69 percent and that legislation would have decreased the federal share to 72.69 percent. From the State’s perspective, if that legislation had been enacted, it would have increased the state share for CHIP in the middle of the fiscal year by 534 percent.

That change would have increased Oklahoma’s budget shortfall this year, and consequently, it could have resulted in harm to both the providers and children enrolled in SoonerCare.

Although there is some rationale for considering changes to the matching rate in the future, particularly with respect to the match associated with administrative costs as those costs probably should be more evenly shared, making such a change in the middle of this fiscal year would be detrimental to three concerns that Rep. Mullin had previously asserted: concerns about Oklahoma’s budget deficit, impact on health care providers, and the health of children.

Second, and far more concerning and potentially harmful to children is a provision in the bill, the “Preserving Access to Medicaid for Americans (PAMA) Act of 2016” (H.R. 5375) that was introduced by Rep. Mullin on May 27, 2016. While the bill’s title includes the words “Preserving Access,” paradoxically, the legislation does the exact opposite when it comes to protecting the health coverage of over 8 million of our nation’s children enrolled in CHIP by eliminating the law’s “Maintenance of Effort” (MOE) requirement.

The MOE prevents states from eliminating or slashing their CHIP programs and dumping children into Obamacare, weaker private coverage, or worse, into the ranks of the uninsured. If the MOE were to be eliminated, children in working families across the nation would lose a trustworthy, proven source of coverage and be put in harm’s way.

This type of legislative approach had been raised before in Congress by former Rep. Phillip Gingrey (R-GA) and Sen. Orrin Hatch (R-UT) in 2011. That bill, the “State Flexibility Act” was analyzed by the Congressional Budget Office (CBO), which estimated that, if the legislation had been passed five years ago, there would have been a “reduction in CHIP enrollment of about 1.7 million people.”

Similarly, with just that one sentence in Sec. 2 of Rep. Mullin’s bill, the demise of CHIP and the coverage it offers to millions of children would be placed in jeopardy. As First Focus Campaign for Children said in a letter to Congress on June 1, 2011, in opposition to the “State Flexibility Act”:

It is ironic and hopefully unintentional that that a large share of those children would be left uninsured or shifted out of CHIP and into inferior coverage in [Obamacare] insurance exchanges plans that proponents of H.R. 1683 have sought to repeal.

That same concern and objection holds true five years later. And, although some states would save money by shifting children from low-income working families into the ranks of the uninsured or into Obamacare, it be devastating to the health care for millions of children, harm providers, and lead to an expansion of Obamacare — all things that Rep. Mullin professes to oppose.

Therefore, we would urge Rep. Mullin to strike, delete, or discard Sec. 2 in PAMA. In his own words, “giving [children] access to the tools and resources they need to maintain a healthy lifestyle is vital to their growth and development in adulthood.” For 8 million children across this country, that is CHIP.

Instead of putting the health coverage of children at risk, we urge Congress and Rep. Mullin to adopt two key principles:

First, Congress should do no harm. For children enrolled in CHIP, that means protecting past progress and not enacting any policy that would make children worse off in terms of their health coverage. From vaccinations, well-child check-ups, and chronic disease management, to oral health and vision care, Medicaid and CHIP ensure that children get the services they need to grow, develop, and go to school ready to learn. It makes no sense to disrupt this successful coverage for kids.

Second, Congress must ensure that our health system continues to support care for children that meets their unique health and developmental needs, including the availability of pediatric networks of care delivery. There is a reason we have pediatricians and children’s hospitals in this country, as children are not just little adults. Medicaid and CHIP recognize that children have special and distinct needs and these programs are designed to ensure that children can get the high quality care they need and deserve.

Unfortunately, Sec. 2 in H.R. 5375, even though it is just a single sentence long, violates both principles. As highlighted by CBO in its past analysis of a similar provision, eliminating the CHIP MOE undermines coverage for children in both the short- and long-term. It removes children from CHIP coverage, which is, by definition, specifically designed for children, and causes children to either become uninsured or moved into insurance exchanges that will be far weaker than CHIP and that Rep. Mullin has voted repeatedly to eliminate.

On this last point, Republican Congressmen Charles Dent, Todd Russell Platts, Bill Shuster, Jim Gerlach, and Glenn Thompson of Pennsylvania strongly opposed the very idea of moving children out of CHIP into the insurance exchanges back in November 7, 2009, during consideration of the ACA. As the Republican congressmen wrote in a letter to then-Speaker Nancy Pelosi (D-CA):

We are writing to express our grave concerns with provisions included in H.R. 3962, the Affordable Health Care for America Act, that would eliminate the Children’s Health Insurance Program (CHIP) and require all children. . .who are not covered under a Medicaid CHIP (M-CHIP) expansion program to be moved into the new health insurance exchange.

The Pennsylvania congressmen go on to explain how CHIP has been an “overwhelming success” since its inception. They explain:

There is no better example of a public-private health partnership that has contributed to the lives of Pennsylvania families. We often hear from our constituents that their children are healthy and active because of CHIP.

They add that CHIP is “an efficient program that provides Pennsylvania children with affordable, quality care” and that moving children from CHIP into the insurance exchanges would result in “a step in the wrong direction for our nation — imposing higher costs and delivering fewer benefits to our most vulnerable population.”

Unless Rep. Mullin has had a change of heart and has decided to expand Obamacare rather than repeal it, we would urge him to take the advice of his Republican colleagues who argued that we should leave CHIP intact rather than dismantle it. As they conclude:

Protecting children, especially those most in need, should be one of Congress’s top priorities in the context of health reform.

We couldn’t agree more.

 

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