Congress is already doing real damage to CHIP

Congress is already doing real damage to CHIP

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Nearly two months since its funding technically expired, the Children’s Health Insurance Program is still in limbo while congressional Republicans try to pass their tax bill.

There was a lot of good reporting over the past week about how states are preparing for the possible end of funding for CHIP, which covers more than 9 million Americans.

Then on Monday, Colorado announced it would start sending letters to families enrolled in CHIP, letting them know what their options would be if the program actually ran out of money. The state projects its reserves for CHIP, which covers 167,000 people, will be dry at the end of January.

States warned us this would happen if Congress left the matter unresolved. Some families might be able to buy coverage on their state’s Obamacare marketplaces, as Colorado is notifying its residents, but the fear is that some number of children would become uninsured.

“A fair amount of our children we think will become uninsured,” Alabama CHIP director Cathy Caldwell told reporters earlier this fall. The program helps cover 150,000 kids in her state.

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With the stakes so high, most people in Washington still believe Congress will act to fund CHIP next month, as a slew of must-pass bills come up on the House and Senate floors. CHIP shouldn’t go unaided forever.

But lawmakers could still be doing real damage to the program.

Florida learned this lesson about a decade ago, Steve Freedman, a University of South Florida health policy professor who sits on the CHIP board there, told me recently.

They call it the “CHIP dip.”

In 2003 and 2004, the state enacted new restrictions on CHIP enrollment. Enrollment declined. Then Florida officials decided in 2005 they’d made a mistake. The program’s rolls had shrunk from 337,000 and kept falling to less than 200,000 at their lowest point.

The state took steps to expand enrollment again. But it took years to bring people back into the program, and even in 2010, CHIP enrollment was still significantly lower than it was before the state’s initial rollback, just a little more than 250,000.

CHIP enrollment in Florida

Freedman said people in the state attributed that prolonged depressed enrollment to the uncertainty around the program in those years more than any specific policy change.

Not unlike what states are experiencing now while Congress drags its feet funding CHIP.

“Every time one of those kinds of things happens, we have to retool our relationships with families,” he told me. “When you start fiddling with people’s economic security, particularly their children’s health care, that’s really a sensitive place to screw around.”

Quote of the Day

This is not a populist tax bill. The tax overhaul that is distracting Republicans while CHIP goes unfunded means more for health care than even VoxCare readers might appreciate. In the long run, if the deficit rises as projected under this bill, Congress is going to face more pressure to cut spending on Social Security and Medicare. Melissa Favreault went through the issue in this excellent Urban Institute piece.

Kliff’s Notes

With research help from Caitlin Davis

Today’s top news

  • “Some Republicans willing to add reinsurance funding to Obamacare”: “Some Senate Republicans embraced the idea of adding more funding for Obamacare insurers to help cover the most expensive customers in an effort to lower premiums. But a top Democrat was skeptical that adding funds for a reinsurance program could offset the impact of repealing the law’s individual mandate.” —Robert King, Washington Examiner
  • “Arkansas cuts off Medicaid funds to Planned Parenthood following court ruling”: “Arkansas has once again cut off Medicaid funding to Planned Parenthood following a recent court ruling. The state’s Department of Human Services said it terminated Planned Parenthood’s status as a Medicaid provider last week when the court’s ruling formally took effect.” —Jessie Hellmann, the Hill
  • “Puerto Rico’s Medical Manufacturers Worry Federal Tax Plan Could Kill Storm Recovery”: “More than two months after Hurricane Maria, the only power for many of these companies comes from emergency generators. They’re also facing logistical problems and staffing shortages that have left some manufacturers unable to keep up with demand.” —Greg Allen and Marisa Peñaloza, NPR

Analysis and longer reads

  • “How Opioids Started Killing Americans”: “More than half of all people who succumbed to an overdose between 2001 to 2007 were chronic pain sufferers who filled an opioid prescription and sometimes even saw a doctor in the month before they died.” —Natasha Rausch, Bloomberg
  • “Making an extra $10 could cost you $24,000 more for health insurance”: “’The disparity between the cost of health insurance for people eligible for the subsidy and middle-class people who are not is huge,’ said Larry Levitt, a policy expert at the Kaiser Family Foundation. It stems in large part from the Trump administration’s decision to end certain payments to health insurers and steps that Wisconsin and other states have taken in response.” —Guy Boulton, Milwaukee Journal-Sentinel
  • “Heated And Deep-Pocketed Battle Erupts Over 340B Drug Discount Program”: “A 25-year-old federal drug discount program has grown so big and controversial that it faces a fight for survival as federal officials and lawmakers furiously debate the program’s reach. The program, known as 340B, requires pharmaceutical companies to give steep discounts to hospitals and clinics that serve high volumes of low-income patients.” —Sarah Jane Tribble, Kaiser Health News

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