Ed Walz
(202) 657-0685 (office)

Washington — A new brief released today by the bipartisan children’s advocacy organization First Focus identifies important similarities between implementation of the bipartisan 1997 legislation creating the Children’s Health Insurance Program (CHIP) and implementation of the Affordable Care Act (ACA). CHIP Roll Out and Early Enrollment – Implications for the ACA was authored for First Focus by Eugene Lewit, a Consulting Professor of Health Research and Policy at Stanford University. Lewit concludes that CHIP enrollment during the late 1990s and early 2000s predicts relatively low ACA enrollment during the first few years, followed by rapid acceleration in later years.

“Like CHIP, the ACA might start slow, but if state and national leaders make the right choices, we should see big coverage gains down the line,” said First Focus President Bruce Lesley.

The brief details that CHIP’s launch was slowed by uneven and inconsistent variations across states, as well as technical and operational problems in individual state systems. Lewit acknowledges that the ACA’s coverage options are more comprehensive and complex than those created by CHIP, and that the ACA faces a tougher political climate. He observes, however, that there are important implementation factors that contributed to CHIP’s ultimate success and would contribute to effective enrollment gains under the ACA:

ACA policy elements were informed by CHIP’s experience, like the ACA’s “no wrong door” and “screen-and-enroll” provisions – these help to ensure that applicants who apply for one coverage option (like the new “exchange” insurance marketplaces) but are eligible for another (like CHIP) get covered instead of denied;
CHIP succeeded in part because the federal government publicly announced national and state-specific enrollment targets, benchmarks with no current parallels in ACA implementation efforts;
In California and other states with the biggest CHIP enrollment gains, CHIP implementation was characterized by constant on-the-ground monitoring to help policymakers identify and understand coverage obstacles in real time; and
Continuous improvement to address coverage obstacles, especially when state and federal officials actively engage advocates and the public.
“As CHIP’s success demonstrates, it takes time, effort and engagement to make things right, but that builds support for the program and momentum for further progress,” said Lewit.

The enrollment trends brief is the first in a planned series examining the CHIP implementation experience as a guide to effective ACA implementation. Upcoming briefs are expected to focus on educating the public about the new coverage options, CHIP’s continuing role as a critical investment in children’s health, and other issues.

“CHIP is a bipartisan success story today,” said Lesley. “In part, that’s because policymakers worked together to fix the glitches and get kids covered.”