THE BLOG

CHIP: Don't Mess With Success

05/05/2014 01:30 pm ET | Updated Jul 05, 2014
  • Bruce Lesley President, First Focus & First Focus Campaign for Children
Alamy

Conventional wisdom offers a few dictums that should apply to the Children's Health Insurance Program (CHIP), including:

  • "Don't mess with success."
  • "If it ain't broke, don't fix it."
  • "Leave well enough alone."

For the sake and well-being of 8 million children across the nation receiving health coverage through the successful Children's Health Insurance Program (CHIP), let's hope that Congress listens to common sense and heeds these simple words as they consider and deal with the future of CHIP.

Since its inception in 1997 as a bipartisan initiative of a Republican Congress and President Bill Clinton, this federal-state partnership has been successfully implemented in every state in the country. According to a Kaiser Family Foundation report, "Over the 1997 to 2012 period the rate of uninsured children was cut in half from 14 percent to a low of 7 percent." This occurred while the uninsured rate for adults ages 19-64 increased over the same time period and stood at 21 percent in 2012, which is three times worse than the rate for children.

The fact is that states across this nation -- under both Democratic and Republican leadership -- have built CHIP to work best for kids through the creation of pediatric-focused health networks that serve their unique health care needs. Since children are "not little adults" and have specific developmental and health concerns, kids need access to medical care from pediatric experts and CHIP, with only rare exceptions, provides it.

According to the Assistant Secretary for Planning and Evaluation (ASPE) at the Department of Health and Human Services (HHS), "A survey of parents of CHIP enrollees in 10 states found that most CHIP enrollees (88 percent) had a usual source of care in the last 12 months and that 83 percent of CHIP parents found it usually or always easy to get appointments. The same survey also found that four-fifths of children received a preventive visit and 86 percent had a doctor or other health professional visit in 2012."

And, as the CHIP evaluation report by Mathematica Policy Research found, 92 percent of parents of CHIP enrollees never or rarely had problems paying their child's medical care. In sharp contrast, nearly half of the uninsured are not confident they can afford to pay for the health care services they need.

In short, CHIP expands health coverage to kids, tailors services and benefits to address the special health care needs of children, improves access to health care, and reduces financial burdens for low-income families. In the face of a raft of bad news for children, including the fact that 22 percent of our America's kids are living in poverty, CHIP stands out as a shining success story.

Fortunately, the American people know a good thing when they see it. In November 2008, a Lake Research Partners survey found that American voters supported renewing CHIP, which was facing expiration in March 2009, by a resounding 82-10 percent margin. And, although not always the case, Congress responded to the wishes of the American people and worked with President Barack Obama to get the Children's Health Insurance Program Reauthorization Act (CHIPRA) passed and signed into law on February 4, 2009.

Four years later, another Lake Research Partners survey found that, despite the partisanship that had developed around the Affordable Care Act (ACA), voters in both political parties strongly supported extending CHIP by a wide 83-13 percent margin. At a time when one-quarter of the American people seem to be so disenchanted and cynical that they oppose everything, it is surprising that CHIP has the support of even half of the "haters" and near unanimous support from everyone else.

With CHIP funding set to expire on September 30, 2015, Congress must, once again, take action to keep the program functioning. Although it may seem a long time away, there are just 50 or so legislative days left in this calendar year and Congress will need to pass something either later this year or early next year in order to give states some certainty that the program will continue.

In light of the fact that CHIP is a resounding success story and strongly supported by the American people versus the fact that the ACA or Obamacare is a work in progress with a majority of the American public still concerned about its implementation, it might seem logical that Congress would adopt the "don't mess with success" dictum and simply extend CHIP. However, as we all know, strange things happen in Congress.

In fact, just this past week, the House Ways and Means Committee voted to extend $310 billion in tax breaks for corporate interests that will greatly increase the federal budget deficit -- a debt that will have to be paid back by our nation's children. And yet, when it comes to our nation's most vulnerable children, that same Committee, on the very same day, stripped a provision out of a child trafficking bill that would guarantee children aging out of foster care access to their birth certificates, Social Security cards, and medical records because the provision would cost an estimated $1 million a year.

Fearing possible inaction by Congress to protect the health of 8 million children getting health coverage through CHIP, over 400 organizations representing all 50 states wrote a letter urging Congress to protect and extend CHIP funding. Although the children's groups are pretty much unanimous in support of the continuation of CHIP, there are surprisingly some in Washington, D.C. who are considering other options.

First, many Republicans are opposed to the idea of eliminating CHIP, as doing so would result in the elimination of a successful and popular source of health coverage for 8 million children. They also worry that CHIP's demise would force millions of kids to move into weaker health coverage under Obamacare's health care exchanges, a program that House Republicans have attempted to repeal 52 times.

So, instead of simply protecting CHIP, House Budget Committee Chairman Paul Ryan has proposed repealing CHIP and moving those kids into a Medicaid block grant that would be simultaneously cut by an astounding $732 billion over 10 years. This would be an unmitigated disaster for kids, as I have written about repeatedly on this blog, including here, here, here, here, and here.

Suffice it to say, this would be a terrible, horrible, no good, very bad idea.

Another idea, which was recently raised at a recent Medicaid and CHIP Payment and Access Commission (MACPAC) meeting, acknowledges that moving kids from CHIP to the ACA insurance exchanges would leave all 8 million children worse off because an estimated 1.9 million CHIP kids would lose coverage entirely due to the "kid or family glitch" in the ACA and the remaining 6 million or so would find themselves with higher cost sharing and weaker benefits, including much weaker dental coverage, in either the health insurance exchanges or the individual market. Yet again, rather than simply protecting CHIP, the recommendation calls for moving CHIP kids into ACA health exchanges in 2017 - a two-year transition period.

The argument is that somehow the ACA shortcomings for children due to the "kid glitch," cost sharing, benefit, and provider network problems can only be fixed if you end CHIP and force some sort of major change. This is sort of the idea that "things have got to become worse before you can make it better" and the notion comes from a good place.

However, there are three significant problems here. First, there currently is not a policy fix or legislative proposal out there about how Congress could address the "kid glitch," the cost sharing differences, the benefit shortfalls, or the provider network inadequacies of the ACA in comparison to CHIP. There is an enormous leap of faith here that assumes the solutions will suddenly appear and get all worked out.

Unfortunately, since enactment of the ACA, there have been over 100 organizations calling for a fix to the "kid glitch", and yet, years later there still is no consensus on how best to do that or any legislative proposal introduced to fix the problem.

Beyond violating the "if it ain't broke, don't fix it", the "leave well enough alone", and the "don't mess with success" dictums for CHIP, there is another source of wisdom that should apply here. As the mother of one of my high school friends yelled out to us from her porch while we were tinkering with his car in the driveway, "Kids, if you don't know how to fix it, for heaven's sake, don't break it!"

Second, such a proposal is a major gamble with the health of millions of children. It presupposes that Congress would choose to work in a bipartisan manner in order to formulate a pretty extensive legislative proposal that would make substantial improvements in the Affordable Care Act to ensure that all 8 million CHIP kids would be able to transition to plans in the newly created exchanges that would be comparable to what took 17 years to develop and build in CHIP. It also assumes that the House, which has voted 52 times to repeal Obamacare since its enactment, would suddenly reverse course and choose to work to make Obamacare better. Not even the greatest of circus elephants can achieve such a flip.

For the 8 million kids served by CHIP today, we simply can't put their health coverage at risk in this way. And, as I have urged previously, children should never be put in a position where they could be at risk of being collateral damage in a game of political brinksmanship.

Instead, we are asking Congress to protect, extend, and make CHIP permanent. If the day comes when Congress chooses to act in a bipartisan way and fix any shortcomings and glitches with the ACA so that it is fully comparable to CHIP, it is at that point when we could consider transitioning kids into the ACA.

But until that time, we should recognize that CHIP works well for kids and choose to not mess with success.