As regular readers of SayAhhh! know, funding for the Children’s Health Insurance Program (CHIP) will expire on September 30, 2017. Medicaid and CHIP have worked together to bring the nation’s uninsurance rate for children down to a historic high of 95%. Whether the country will continue moving forward on this critical question is a key issue that will be impacted by Congressional decisions that lie ahead. Even though CHIP is a very popular program, with all of the chaos in Washington, I am starting to get worried about whether Congress can get its act together and get this done soon.
Most states have already started their legislative sessions – some of which are very short. So important decisions about state budgets are already moving along. At the moment, with no clear direction from Congress, state leaders do not know at what level CHIP will be funded, or even whether it will be funded at all. Moreover, state CHIP administrators need significant lead time to start informing families about upcoming changes or cuts to the program should Congress go in that direction.
And let’s not forget that as the world changes, and the future of the ACA-established marketplaces looks precarious, the role Medicaid and CHIP serve for kids has become even more important. If CHIP disappeared, families would no longer be certain that marketplace coverage would be there as a back-up option for their children.
MACPAC, the congressionally-chartered commission set up to advise Congress on the future of Medicaid and CHIP, recently recommended that CHIP be extended for five years with the current maintenance-of-effort (MOE) and funding levels intact – including the “CHIP bump”. All of these are very important and good recommendations to protect children from our current political turmoil over publicly funded health coverage. A five-year extension is critical so that we don’t have to go through this exercise again. It would assure some stability for the program going forward. Extending the maintenance-of-effort requirement and continuing current funding levels are also vital.
I think of the maintenance-of-effort provision as the “don’t mess with success” provision of the Affordable Care Act. The uninsured rate for children was already moving in the right direction prior to enactment of the ACA, thanks to Medicaid and CHIP, so requiring states to continue at the same eligibility level was an important ACA provision to protect children’s health at a time when the health care landscape was shifting. Today, in 2017, that is even more true with the repeal of the ACA a top agenda item for Congress. Ensuring that stability of coverage remains in place for children is even more important now that there is so much chaos and confusion surrounding health coverage.
Parents are happy with the coverage CHIP is providing to their children. In 2015, the Kaiser Family Foundation conducted focus group research on parent’s views about their children’s health coverage and included many parents whose kids were on CHIP. As my colleague Elisabeth Burak blogged about then parents’ top priority for their children’s coverage was to ensure that coverage was affordable and comprehensive. We know from extensive research that CHIP meets those tests. In the Kaiser study, parents with employer-sponsored insurance reported that they experienced significant cost barriers to needed care for their children and worried about high out-of-pocket expenses —some citing very high deductible private plans, which are generally not permitted in CHIP.
Another key issue that may arise in the CHIP debate is whether parents really want their kids in the same plans as themselves. I have never seen any solid evidence to back up this claim though, and parents in the Kaiser study said this was not a top priority – the affordability and comprehensiveness of coverage was their top concern. A soon-to-be released study by the University of Alabama reinforces this finding – a survey of just under 1200 parents found that 79% said that having children on a different plan from their parents was not a problem at all – only 12% viewed this as a big problem.
Thinking optimistically, I would argue that CHIP could be a relatively simple move for Congress (I say simple as relative to other impending health policy decisions!). Given that CHIP is working well as is, although it should be noted only because it sits on the shoulders of a strong Medicaid program, a clean extension that ensures this important source of coverage for children remains strong and stable would be a victory for all.