CHIP Turns 20: A Not So Happy Birthday

A teen girl is bored and sad on a birthday party

Saturday marks the twentieth anniversary of the Children’s Health Insurance Program (CHIP), which was signed into law on August 5th, 1997 by President Bill Clinton as part of the Balanced Budget Act. As readers of SayAhhh! know, CHIP and its companion Medicaid, have done an amazing job of reducing the number of uninsured children to historic lows in 2015.

While the vast majority of these children are covered in Medicaid, CHIP stimulated an enormous, national, bipartisan effort to prioritize covering children — through outreach efforts, eligibility simplifications for both programs, and of course new coverage opportunities for children whose families were earning a bit too much for Medicaid but not enough to afford private insurance. At last check, 95% of children had coverage.

It is easy for me to remember how old CHIP is because I was pregnant at the time it was enacted. My daughter will turn 20 in a few months. As I think about that milestone for her, with a tinge of sadness as a parent, I focus on all of the bright possibilities for her future.

Assessing where CHIP stands on the eve of its 20th birthday is a lot more worrisome. As readers of SayAhhh! know, funding for CHIP expires on September 30th, 2017. In a hopeful sign, Senator Orrin Hatch, Chairman of the Senate Finance Committee, announced a bipartisan hearing on CHIP in September. The House Energy and Commerce Committee held a hearing on CHIP earlier this year but so far Congress has taken no action at all to extend CHIP funding. Only 57 days remain before CHIP runs out of money and Congress is not in session for the vast majority of those days. States and families have no assurances about what is going to happen.

We all know why Congress has been distracted. And the good news for CHIP is that Medicaid and its financing structure has emerged unscathed for now. CHIP wouldn’t be able to operate as successfully as it does without standing on the shoulders of Medicaid.

Back in February I wrote a blog urging Congress to act quickly on CHIP. My argument then was that this could be a relatively quick and easy bipartisan health care win as compared to other pending health policy issues! In April we highlighted on SayAhhh! some of the policy choices that we believe Congress should make. Unsurprisingly these pleas fell on deaf ears.

And now the CHIP program faces its birthday with a huge amount of uncertainty for those who rely on the program for their children’s coverage as well as the state administrators and legislators who run and budget for the program. Will the match rate change? How long will the program be extended for? What will happen to the maintenance of effort requirement that ensures that states must keep their coverage stable for children in this time of turmoil? How can a state even run a responsible program with contracting obligations etc in this situation?

We at CCF think a five-year extension of CHIP with the MOE and the match intact until FY 2022 would be the responsible choice to make as it is extremely important to protect children from losing health coverage during these tumultuous times. This is even more important now as it seems clear that the marketplace is fated with uncertainty at best in the near future and active sabotage at worst. Our colleague Sabrina Corlette has a great blog summarizing some of these threats.

And of course the biggest question is will the program be extended at all? I find it hard to believe that Congress will let this funding expire, but I have growing concerns given the disarray and the huge agenda Congress faces in September – which includes funding not just CHIP but all aspects of government – and raising the debt ceiling.

For the nearly 9 million children whose coverage is financed and/or provided through CHIP, this is a very serious matter with real consequences. By acting quickly and responsibly as soon as it returns, Congress could provide parents with peace-of-mind on the concern that is on the top of their minds – their child’s health.

Editor’s note: Read more about the future of CHIP as the program turns 20

Joan Alker
Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy

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