Why We Must Act to Protect the Health of 10 Million Children…Now!
Pass H.R. 6151, the Finkenauer-Buchanan ‘CARING for Kids Act’
To protect the health coverage of 10 million children, Congress should pass H.R. 6151, the “CARING for Kids Act” sponsored by Reps. Abby Finkenauer (D-IA) and Vern Buchanan (R-FL).
The bipartisan House bill would:
- Protect the health coverage for 10 million children that receive health care coverage through the Children’s Health Insurance Program (CHIP) permanently;
- Ensure fairness for children’s health care coverage (no other federal health program expires or is subjected to funding cliffs);
- Address a potential emergency to CHIP whereby the program could be subjected to enormous “collateral damage” due to a pending Supreme Court case or other congressional action related to the Affordable Care Act (ACA);
- Prevent CHIP from being used as a “political football” or “bargaining chip” again; and,
- Allow health experts, advocates, and states to shift their focus to program innovation and other important problems facing children, such as infant mortality, mental health, substance abuse, diabetes, asthma, and oral health.
CHIP Is a Bipartisan Success Story
Over the program’s 23-year history, CHIP has quietly gone about its business in providing comprehensive, effective, pediatric-focused health care for 10 million children in this country. It is the definition of a success story, as it has working in tandem with Medicaid to successfully cut the uninsured rate for our nation’s children from 15 percent in 1997 to less than 5 percent in 2015.
The ‘CARING for Kids Act’ Protects Child Health
And yet, CHIP’s status and future is frequently threatened. Every few years, CHIP is subjected to the danger of being eliminated due to arbitrary deadlines that often leads to anxiety, grave concern, and chaos among families with children, health providers, and state programs.
As an example, in November 2017, a little more than a month after Congress has failed to extend CHIP’s funding past a September 30, 2017, deadline, Myra Gregory described the threat that the CHIP funding expiration posed for her 11-year-old son Roland, who was diagnosed with lung cancer earlier that year. In her editorial in the St. Louis Post-Dispatch, Gregory described the frustration and desperation CHIP’s expiration had placed on her family:
I understand that our society is divided right now. I understand that Republicans and Democrats can have honest differences of opinion. What I cannot understand is how the U.S. Congress could make the health security of kids like Roland a guessing game, and their lives bargaining chips. Watching my baby fight for his life this past year has been agonizing. I’ve held him in my arms while he cries in pain, I’ve experienced anxiety and stress I thought I would never overcome, and I have had to have conversations with Roland’s younger brothers that no child should have to have. I have always known that our situation could get worse, but I never imagined that Congress would be an obstacle in my son’s battle with cancer.
We should never gamble with or put at risk the health of children. H.R. 6151, the “CARING for Kids Act,” would eliminate the arbitrary expiration date for the program and make CHIP permanent.
THE ‘CARING for Kids Act’ Is About Simple Fairness
Protecting the health of children is also a matter of simple fairness. CHIP is the only federal program that is subjected to expirations, funding cliffs, the need for offsets, and threats of “political hostage taking” in order to simply maintain the status quo with “an act of Congress,” which is used as a metaphor to describe something that is difficult to get accomplished. All other federal programs, including Medicare, Medicaid, the Veterans Administration, TRICARE for military personnel and families, the Federal Employees Health Benefits Program (FEHBP), and tax credits for private health insurance, are permanent and never subjected to repeatedly termination dates.
CHIP also includes a “funding cliff” that has historically created arbitrary shortfalls that imposes a burden upon CHIP that requires billions in budget cuts or “offsets” just to extend the status quo of health coverage to children. No other federal program is subjected to this enormous barrier to its continuation and that burden has caused CHIP to expire for periods of time in the past.
The Finkenauer-Buchanan bill recognizes that the health of 10 million children deserves better than temporary or second-class status. H.R. 6151 would fairly put CHIP on equal status with all other federal health insurance programs.
The ‘CARING For Kids Act’ Eliminates Potential Threats to Child Health
There is also urgency around the issue of making CHIP permanent now. The potential crisis is caused by the fact that Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) scoring of CHIP is highly dependent upon its interaction with other health programs, including the Affordable Care Act (ACA), Medicaid, private insurance, and becoming uninsured.
In 2018, CBO and JCT estimated that retaining health coverage for the millions of children enrolled in CHIP is more cost effective against the alternatives for children. According to estimates by CBO and JCT, “Extending funding for CHIP for 10 years yields net savings to the federal government because the federal costs of the alternatives to providing coverage through CHIP (primarily Medicaid, subsidized coverage in the marketplaces, and employment-based insurance) are larger than the costs of providing coverage through CHIP during that period. . . The agencies estimate that enacting such legislation [to extend CHIP for 10 years] would decrease the deficit by $6.0 billion over the 2018–2027 period.”
Therefore, if Congress were to act to pass H.R. 6151 and protect CHIP now, it would likely be scored to either save the federal government money or be free, which would eliminate the need for offsets. In other words, maintaining CHIP would be less expensive to the federal government than the alternatives of ACA, Medicaid, or private insurance coverage for children.
However, if Congress fails to act now, the pending Supreme Court case of Texas vs. Azar, administrative actions, or other legislation before the Congress could substantively alter the ACA, and consequently, the CHIP score for the negative. If ACA coverage were undercut or eliminated, the alternative to CHIP would be that children would become uninsured. In that circumstance, efforts to extend or reauthorize CHIP might be “scored” by CBO and JCT to cost tens of billions of dollars.
In that occurs, it might prove nearly impossible to extend CHIP due to the need to find enormous funding offsets. Consequently, CHIP and the health care coverage to 10 million children might become a victim of unintended “collateral damage” from judicial, administrative, or legislative changes to programs that have little or nothing to do with CHIP.
Again, we should never gamble with or put at risk the health of our nation’s children. The “CARING for Kids Act” (H.R. 6151) would prevent this potential disaster from happening and protect children’s health care coverage now and into the future.
The ‘CARING for Kids Act’ Ends the Practice of Using CHIP as a Bargaining Chip
Some have argued they like for CHIP to expire because it gives Congress a chance to think about how the program is working or could be improved. The fact is that Congress should use its oversight authority to do that all that time rather than just every few years.
But more importantly, even though there is strong bipartisan agreement and support for CHIP, political disagreements on issues unrelated to CHIP, such as health care reform, Medicare and Medicaid offsets, the federal budget, and immigration reform, have often proven to be the major barrier for Congress to act in a timely manner on CHIP.
Paradoxically, the fact that CHIP is wildly popular has often led to such uncertainty because some outside groups and politicians have attempted to drag CHIP into unrelated contentious political debates. As a result, children’s advocates have repeatedly called for “CHIP to not be used as a bargaining chip.”
During the debate over the last set of extensions of CHIP in 2017 and 2018, CHIP funding was initially set by Congress to expire on September 30, 2017. Unfortunately, as CHIP was effectively “taken hostage” for the purpose of political leverage in unrelated policy debates, Congress had to pass three separate funding extensions and reach agreement on a final budget deal to ensure CHIP’s ultimate reauthorization on February 9, 2018 (more than four months or 132 days after it had initially expired).
The program’s expiration and delay in its extension occurred despite: (1) 88 percent of American voters saying in November 2017 that reauthorizing CHIP funding should be a top or important priority of President Trump and Congress; and, (2) dire warnings about the negative consequences that failure to extend CHIP would have on coverage.
Linda Nablo, the chief deputy director of the Virginia Department of Medical Assistance Services explained, “CHIP is being used as a pawn in larger debates and negotiations. It has fallen victim to the dysfunction and partisanship in Congress.”
The problem is that legislative battles to extend CHIP are rarely about improving the program and far more to be about using CHIP’s popularity as a “bargaining chip” to push other political agendas. The program’s expirations have created real harm. The uninsured rate for children increased in 2017 and 2018 for the first time in over a decade in part because states were forced to cancel back-to-school outreach and enrollment activities for children’s health coverage in September 2017 in the face of CHIP’s struggle to get reauthorized for more than four months.
At the end of this blog are just a sample of the articles highlighting how CHIP was used as a “bargaining chip” during the 2017–2018 debate over CHIP’s expiration and one from 2015 highlighting the reoccurring theme.
The health and well-being of children should never be used as political pawns or bargaining chips in politics, and the “CARING for Kids Act” would protect children from such damaging gamesmanship in the future.
The “CARING for Kids Act’ Would Allow for a More Comprehensive Focus on Child Health
While CHIP has been wildly successful at improving the health care coverage of children and the public, parents, and states are wildly supportive of it, we should always strive to improve the health of our children.
Unfortunately, over the years, the attention of Congress, child advocates, health care providers, and states have largely been focused on the need to protect CHIP from repeated threats rather than focusing on program innovation and other important child health issues, such as:
- Covering all children/reversing recent rise in uninsured children;
- Rising health care costs;
- Infant mortality;
- Childhood cancer;
- Developmental screenings and services;
- Children with special health care needs;
- Rising suicide rates;
- Mental and behavioral health;
- Substance abuse;
- Impact of opioids on children;
- Fetal alcohol syndrome;
- Diabetes;
- Asthma;
- Oral health;
- Vision care;
- Preventive services;
- Emergency medical services;
- School-based health services;
- Immunization rates;
- Teenage pregnancy;
- Pediatric medical research;
- Social determinants of health; and,
- Racial and ethnic disparities.
H.R. 6151 would allow Congress, child advocates, health care providers, and states to work on ways to improve the health of our nation’s children rather than having to plan and contingency plan for CHIP’s possible demise, work to extend current law, and having to deal with repeated and unnecessary battles to simply extend CHIP. Over its 23-year history, CHIP has needed at least 25 different laws to either address funding shortfalls in the early years or to simply extend the program in the last 13 years, including the four different laws in 2017–2018.
In light of the coronavirus public health crisis, we should all be grateful that CHIP is not up for extension at this moment in time. We need state health departments to be entirely focused and attentive to the critically important task of addressing the coronavirus pandemic. However, if CHIP was up for expiration, states would have no choice but to be diverting some of their attention toward preparing and contingency planning for the possible temporary expiration or end of CHIP.
Children deserve much better from adults than self-imposed unnecessary deadlines, unrelated political battles, and enormous energy being spent merely to maintain the status quo.
If all that time and effort were instead used to focus on improving the lives and health of children, we would all benefit.
As the Children’s Bureau pointed out in 1918 (over a century ago), “The health of the child is the power of the nation.”
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Related Articles: CHIP as a Political Bargaining Chip
Sarah Ferris, “Advocates: Don’t Turn Children’s Insurance Into Medicare Bargaining Chip,” The Hill, Mar. 19, 2015, https://thehill.com/policy/healthcare/236351-advocates-dont-turn-childrens-insurance-into-medicare-bargaining-chip
Jonathan Oberlander and David Jones, “The Children’s Cliff — Extending CHIP,” New England Journal of Medicine, May 21, 2015, https://www.nejm.org/doi/full/10.1056/NEJMp1503576
Dylan Scott, “This is the Nightmare Scenario for the Children’s Health Insurance Program,” Vox, Oct. 26, 2017, https://www.vox.com/policy-and-politics/2017/10/26/16554682/voxcare-childrens-health-insurance-program-nightmare
Colby Itkowitz and and Sandhya Somashekhar, “States Prepare to Shut Down Children’s Health Programs if Congress Doesn’t Act,” Nov. 23, 2017, https://www.washingtonpost.com/national/health-science/states-prepare-to-shut-down-childrens-health-programs-if-congress-doesnt-act/2017/11/23/01a6169e-ba7d-11e7-be94-fabb0f1e9ffb_story.html
Abby Goodnough and Robert Pear, “The CHIP Program Is Beloved. Why Is Its Funding in Danger?” Dec. 5, 2017, https://www.nytimes.com/2017/12/05/health/childrens-health-insurance-program.html
Robert Pear, “With Children’s Health Program Running Dry, Parents Beg Congress: ‘Do the Right Thing,’” New York Times, Dec. 19, 2017, https://www.nytimes.com/2017/12/19/us/politics/chip-childrens-health-insurance-program-congress.html
Dylan Scott, “Congress Has 11 Days Before the CHIP Nightmare Gets Very Real,” Vox, Dec. 20, 2017, https://www.vox.com/policy-and-politics/2017/12/20/16802440/congress-11-days-chip-nightmare
David Leonhardt,, “Taking Health Care From Kids,” Dec. 21, 2017, https://www.nytimes.com/2017/12/21/opinion/tax-bill-chip.html
Sam Baker, “Paul Ryan’s Latest Bargaining CHIP,” Axios, Jan. 17, 2018, https://www.axios.com/paul-ryans-latest-bargaining-chip-1516190281-ccff75da-8681-4094-98df-0f8f6e237ee8.html
Sarah Kliff, “Congress Let CHIP’s Funding Expire 110 Days Ago, and It’s a National Disgrace: Health Insurance for Kids Has Officially Become a Political Bargaining Chip,” Vox, Jan. 17, 2018, https://www.vox.com/policy-and-politics/2018/1/9/16860802/chip-funding-expired-congress
Simon Haeder, “Time to Stop Using 9 Million Children as a Bargaining Chip,” The Conversation, Jan. 18, 2018, http://theconversation.com/time-to-stop-using-9-million-children-as-a-bargaining-chip-90293
Paige Winfield Cunningham, “The Health 202: Here’s How Children’s Health Became a Bargaining CHIP in Government Shutdown Talks,” Washington Post, Jan. 19, 2018, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/01/19/the-health-202-here-s-how-children-s-health-became-a-bargaining-chip-in-government-shutdown-talks/5a60e36c30fb0469e88401f7/
Dylan Scott, “Children’s Health Insurance Has Become a Political Hostage,” Vox, Jan. 19, 2018, https://www.vox.com/policy-and-politics/2018/1/18/16901526/congress-chip-crisis
Dylan Scott, “The Government Is Still Shut Down and CHIP Is Still Unfunded,” Vox, Jan. 22, 2018, https://www.vox.com/policy-and-politics/2018/1/22/16917800/government-shutdown-2018-chip
Elaine Cox, “Children’s Health: A Political Bargaining CHIP?”, U.S. News and World Report, Feb. 2, 2018, https://health.usnews.com/health-care/for-better/articles/2018-02-02/childrens-health-a-political-bargaining-chip
