The ink is barely dry on the law extending the Children’s Health Insurance Program (CHIP) funding through 2017, and I’m already hearing rumblings in the health policy community foreshadowing the program’s inevitable demise in 2017. I’ve heard phrases such as: “when CHIP ends”; “How do we best phase out CHIP?” and “We assume CHIP will not continue.”
Hold on.
Before we start heading down that path, let’s return to the very place we started two-plus years ago when CHIP also faced an uncertain future. Back then, we focused the conversation on the most critical question: “What do children need?” Notably, the conversation on CHIP’s future did not start with: “What is the least complicated for policymakers?” or “What programmatically makes the most sense?” We asked instead: “What is best for children?” That’s exactly the overriding principle that should drive the conversation today.
So what do children need? Affordable, high-quality coverage. And their families need continued financially stability.
Where we initiate the conversation on the future of kids’ coverage (including, but not limited solely to CHIP) is MUCH more important than any discussion about the mechanics of coverage itself. And thanks to research so many groups have done in the past two-plus years, we have strong evidence that kids will unequivocally be worse off without CHIP: At least one million could end up uninsured, and many more would pay much more for coverage that does not fully meet their needs. And it’s likely that this fundamental fact – that kids will be worse off—will not change enough in the next two years to successfully argue that other coverage sources can serve them as well as CHIP does today.
And the research continues. Earlier this month, Kaiser released an illustrative new report on what parents value in their children’s coverage: affordability and broad benefits—two places that research tells us CHIP almost always wins out when compared to QHPs. And while policy minds like to talk about the convenience of streamlined programs and families enrolling in the same plan or program, these parents were clear when asked about whole-family health plans. They said it may be more convenient, but they would stay in separate plans with no problem if it cost less. (This makes sense to me. I do my own calculations each year comparing my employer-sponsored health insurance with my spouse’s insurance offerings to determine where our family of three can get the best coverage at the lowest cost— including many scenarios where our coverage is split between plans. So I bet this convenience-affordability comparison shopping goes on well beyond public programs.)
Should state managers have contingencies ready in case CHIP ends before it should? Yes. And should we work on making all coverage sources better for kids for the possible day when and IF CHIP ends? Of course. Does this mean that we need to assume kids have already lost out before the debate on another extension has even started? Absolutely not. We should use this critical period before the CHIP debate ramps up again to craft our vision of children’s coverage based on what children need. We should not start by asking what programs need or by speculating what policymakers will do before the debate has even begun. Instead, let’s build the case—as we just did!—to show policymakers what children need, what the road ahead should look like, and then — and only then– what it means for the programs in place today. The health policy community should make certain that children’s health needs are at the very center of the debate going forward.
