In a recent interview on the PBS News Hour, Kaiser Health News reporter Sarah Varney asked CMS Administrator Seema Verma about steps the administration is taking to address the troubling increase in the number of uninsured children and its connection to the decrease in child enrollment in Medicaid and CHIP. Readers of SayAhhh! are already familiar with this issue – the significant decline in Medicaid and CHIP enrollment was one of many warning signs that the uninsured rate was going in the wrong direction. Thankfully, as my colleague Tricia Brooks has written, we know how to fix this problem, and one of the key strategies is outreach and consumer assistance. Here’s an excerpt on this point from the interview:
Varney: We know that more health coverage leads to longer life expectancy; I think this has been well established. And I wonder if whether or not the administration should be emphasizing more finding those children who are not enrolled, who are eligible but not enrolled, and perhaps focusing on outreach, which we haven’t really heard your administration talk about?
Verma: Well, again. Our focus is on making sure, especially children, that they have access to high-quality health care. As a mom, I’ve got two kids, so I can personally attest to the fact that having health insurance is very important for children. Something very little, like an ear infection, can lead to deafness if it’s not, you know, treated appropriately. So having that access to high-quality health care is very, very important to their development. The Trump administration is very committed to the Children’s Health Insurance Program; the president signed legislation around that. Additionally, we have spent over $48 million on outreach efforts. We’re very focused on working with states, so that they can identify the best practices to make sure that those individuals, children that qualify, can enroll in the program, that they’re aware that this program exists.
We can all agree on the importance of coverage to children’s healthy development, but I’d like to check the facts on the Trump administration’s commitment to children’s coverage and outreach efforts.
Dating back at least a decade, Congress has mostly* shown a commitment to children’s coverage and outreach by supporting Medicaid’s foundational role in covering children, continuing to fund CHIP, and providing additional resources for outreach and enrollment. Medicaid is the longstanding MVP for children’s coverage, and since 1997, CHIP has helped fill important gaps in coverage for children with family income above the Medicaid eligibility levels but for whom private coverage remains out of reach. In order to maximize these programs and increase coverage rates, Congress created an outreach and enrollment program to help enroll more eligible children. The grants were first authorized by the CHIP Reauthorization Act of 2009 and have continued in subsequent CHIP funding bills, most recently in the HEALTHY KIDS and ACCESS Acts (P.L. 115-120 and P.L. 115-123).
The $48 million spent on outreach that Verma described is in reference to these grants – Congress has provided $20 million per year from 2009 through 2023 and somewhat lower levels of funding for 2024 through 2027. The $20 million includes a 10% set aside for the national children’s coverage campaign and a 10% set aside for outreach specifically to American Indian/Alaska Native children, resulting in $16 million for outreach and enrollment grants each year (or $48 million over 3 years). Unfortunately, even congressional commitment to children’s outreach lapsed in 2017, when the unprecedented delay in CHIP funding resulted in an interruption in outreach efforts too. Still, Congress has more or less remained committed to children’s coverage, even as political leadership has changed.
The Trump administration does not share the same track record. To be clear, any administration would have to rely on Congress to appropriate funds for Medicaid, CHIP, and outreach because the Constitution gives the “power of the purse” to Congress, specifically the House. But administrations have other ways to show their commitment to an issue – the power of the bully pulpit is one – but policy wonks often turn to the President’s annual budget proposal to get an idea of what the administration would like to see happen on a given issue. The President’s budget is the first step in the complex process of funding the federal government, and though it does not itself become law, it lays out the administration’s priorities. What did the President’s most recent budget proposal have to say about children’s coverage and outreach?
The 2020 budget proposal, released in the spring of 2019, proposed cutting Medicaid by $1.5 trillion over a decade (see pages 105-106 for the Medicaid summary), jeopardizing coverage for more than 30 million children nationwide. The only mention of children’s outreach is in reference to the funding Congress appropriated as described above (see pages 109 and 112). The 2020 budget proposal had very little to say about CHIP because Congress had already acted to extend CHIP funding for 10 years, but we need only look back to the 2018 and 2019 budget proposals to see the administration’s CHIP goals. Not only did the Trump administration propose major cuts to Medicaid and fail to seek an extension of the outreach grants, it actually sought to cut children’s coverage even further by reducing the CHIP match, capping CHIP income eligibility below the national median, ending the Medicaid and CHIP maintenance of effort, and reversing what’s known as the “stairstep” provision.
The truth is that this administration has presided over a historic decline in children’s coverage and failed to take the necessary action to reverse the trend. I suppose it’s noteworthy that the administration fulfilled its legal responsibility by issuing the outreach grant money given their track record on Medicaid generally (e.g., allowing unlawful work requirements, premiums, lockouts and other damaging policies through Medicaid waivers; attempting to upend Medicaid rules for immigrants through public charge; soliciting proposals to block grant Medicaid; the list goes on). But there is little if any evidence to back up the claim that the administration is “very committed” to children’s coverage.
*There have been some near-misses, including the existential threats Medicaid faced in 2017, but thankfully proposals to cut and cap Medicaid have failed to pass.