So despite a bipartisan CHIP extension earlier this year, it appears that children’s coverage is not as popular as we may have thought. In fact, if the reconciliation bill as passed becomes law there is a good reason to believe that millions of children would become uninsured; almost assuredly the historic and steady reductions in the number of children’s coverage that we have observed would be reversed.
Here’s why:
- Premium subsidies would go away. Nearly 900,000 children enrolled in marketplace coverage in 2015, the vast majority of whom likely received subsidies. The bill doesn’t contain any new funding to extend CHIP beyond 2017 so these kids would have no back up source of public coverage.
- Medicaid expansion would be repealed – our recent report on declines in the number of uninsured children noted that states that have expanded Medicaid for parents have seen larger declines in the number of uninsured children. This is a finding we expected due to the “welcome mat” effect, where eligible but uninsured children get enrolled when whole family coverage becomes available.
- The maintenance of effort which preserves children’s Medicaid and CHIP eligibility levels currently until 2019 would be eliminated as of September 30 2017. That means that even if Congress enacts additional federal funding for CHIP, states would be free to eliminate or scale back their CHIP programs, with no alternative source of coverage available. Currently 8 million kids are receiving CHIP coverage.
- The so-called “stairstep” children provision who have moved to Medicaid to align family eligibility and provide richer benefits and stronger cost-sharing protections for kids would be eliminated as well as of December 31, 2017. So with no MOE, states could drop this population entirely or continue to serve them in Medicaid at a lower match rate.
It’s been a depressing week for many reasons. This won’t become law since President Obama has already issued a veto letter. But why is the U.S. Senate voting to make millions of children uninsured?
