Compared to what?! – This line is a favorite of my four-year-old from the popular Marcel the Shell with Shoes On web series. If you haven’t had the pleasure of seeing as I have many times, Marcel makes funny observations about his role and size in the world. The full quote (which you can see here around 2:41 if you want to cut to the chase) is:

Some people say that my head is too big for my body, and then I say “Compared to what?!”

With my daughter parroting “Compared to what?!” daily, it occurred to me that the recent MACPAC request for input on the future of kids coverage begs this question. MACPAC asked for input on the very important question of what needs to happen to improve exchange coverage for children, acknowledging that CHIP must remain in place for, per their June recommendation, at least two years. Before posing key questions on how to improve exchange affordability, benefits, network adequacy, and coverage transitions, the request states:

As we develop our analyses and future recommendations, we would like to hear from you on the factors affecting how well exchange coverage meets children’s health and developmental needs, and any changes that should occur to ensure that such needs are met.

And while they acknowledge some necessity in maintaining CHIP while improving exchanges, the questions posed to stakeholders  ask about how to improve exchanges without also raising the obvious question: “Compared to what?” When you look at the coverage millions of kids receive through CHIP today, it provides a built-in standard to ensure no kids are worse off if they eventually move to the marketplace plans.

Today, CCF and 48 other groups submitted a letter challenging some of the underlying assumptions of these questions to underscore the need to keep CHIP strong until we are fully confident children will get the services they need at an affordable cost to their families. Evidence is clear we aren’t there yet, and given the many changes that will need to be made to make exchanges better for kids, for now our default assumption should be that CHIP remains a critical part of the coverage system for children for the foreseeable future—multiple years! As we say in the letter:

Until we can ensure that marketplace coverage is comparable to CHIP coverage, we respectfully submit that any assumption of discontinuing CHIP remains highly premature. Rather, additional time is needed to ensure:

• Existing benefit gaps in marketplace plans are addressed before they can be considered comparable to CHIP; Medicaid and CHIP’s child-focused benefit standards are considerably stronger.

• Any necessary legislation or regulations sufficiently address the current probability that many children and their families could face higher costs for less robust coverage in marketplace plans, as well as the “family glitch,” which could swell the ranks of the uninsured by an estimated 2 million children; and

• State officials and, in turn, marketplace plans have ample time and resources to respond to policy changes that will require a fundamental shift to child-focused and child-designed coverage that is lacking in exchanges today.

We need to keep CHIP and Medicaid a strong part of the conversation about robust children’s coverage even as we work to improve exchanges. For more information, read the 49-group sign-on letter and you can also check out CCF’s longer comments.