What are the Consequences of Congressional Inaction on CHIP?

Funding for the Children’s Health Insurance Program (CHIP) expired 26 days ago and Congress still hasn’t acted. I have been working on CHIP since its inception, and this is unprecedented!

Today we are releasing  a report that unpacks some of the implications of Congressional inaction beyond the beltway. We didn’t survey all 50 states but looked at those where other reports suggested early depletion of funds as well as the five largest CHIP programs in the country.

The children most at risk of losing CHIP coverage soon are those residing in states running out of funds quickly and in states with separate CHIP programs. At least six states – Arizona, California, the District of Columbia, Minnesota, Ohio and Oregon – are predicting they will run out of money by the end of the year or early in January. At least six other states – Colorado, Pennsylvania, Texas, Utah, Virginia and Washington – have announced their intention to take action before the end of the year even if their funding is not running out as quickly. That puts at least 12 states on our emergency watch list, but that could change on a moment’s notice.

Predicting exactly when states will run out of money is extremely difficult because how quickly a state spends down remaining CHIP funding fluctuates considerably and new information is surfacing just about every day. Just this week, the date that Texas is expected to deplete its CHIP allotment moved up by a month. Hurricanes and other natural disasters can have a major impact on how quickly a state draws down its CHIP funding. Successful enrollment drives and other factors can also influence how quickly states run out of money.

Another important issue to consider is that most CHIP programs operate through managed care and capitation payments typically are due at the beginning of the month. This means that the date that states would no longer be able to meet their CHIP obligations maybe a month earlier.

Just as you don’t want to wait until your car’s gas gauge hits empty to pull into the gas station, states cannot wait until they totally exhaust federal CHIP funds to take action. Inaction by Congress is costing states time and money as officials grapple with various “what if” scenarios and develop contingency plans to meet their responsibilities to notify families, managed care plans, providers and other stakeholders of any changes to their state CHIP programs.

Some states such as Utah and Virginia are contemplating temporarily closing down their CHIP programs due to Congressional inaction. Past experience shows that even temporary enrollment freezes are likely to cause significant declines in child enrollment. States are acting very cautiously about sending out notices. As soon as notices go out to families in even one state, it will likely start an “unwelcome mat” effect that may cause kids to become uninsured. Bear in mind that families have been hearing all year that Congress is working on taking away their coverage.  Colorado, Texas, Utah, Virginia and Washington have indicated they will send out notices in November or December.

The longer Congress fails to act on CHIP funding, the more likely it is that children will fall through the cracks and lose coverage. Children going without coverage even for a few months is unnecessary and harmful. Every parent knows that a broken bone or trip to the ER for stitches can happen at any time. And children with asthma who can’t access their regular treatment may get worse leading to more missed days of school  and/or the ER. Any of these common events can expose these working families to unnecessary economic insecurity.

Congressional inaction in some ways is even more mystifying given that there is bipartisan bicameral agreement on CHIP policy! How often does that happen these days? The bad news is that tax reform has shifted focus once again away from the urgency of approving CHIP funding.

The holdup now is getting offsets to pay for CHIP. But extending CHIP would cost less than one half of one percent of federal mandatory outlays. Congress can easily get this done if the importance of children’s health rises to the top of their to-do list. Why risk going backwards on the enormous progress our country has made in reducing uninsured children and improving children’s health?


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.