Congress is about to strike a deal that takes care of seniors and doctors but leaves low-income and “at-risk” children short. Congress’ annual struggle to avoid cuts in Medicare reimbursement rates so physicians will continue to give seniors the care they need is widely considered must-pass bipartisan legislation. Known as the Sustainable Growth Rate (SGR) or “doc fix,” this annual process often provides a vehicle for moving other legislative health priorities. (Last year it included one year of funding for the important Maternal and Infant Early Childhood Home Visiting program.) While Congress has long discussed passing a permanent “doc fix,” leaders in the House of Representatives have now released an outline for doing it and plan to act on it next week. They hope the Senate will follow and act before the current “doc fix” expires March 31.
This is great news for seniors whom we support, but why is Congress leaving children behind by extending funding for the successful bipartisan Children’s Health Insurance Program (CHIP) and the Maternal and Infant Early Childhood Home Visiting (MIECHV) program for only two years? The cost of the “doc fix” is about $140 billion, while a two-year extension of CHIP and home visiting funding is less than $6 billion. Yet in the House proposal this increase required an “offset,” meaning it had to be paid for, while the “doc fix” that is more than 20 times more expensive does not. This is profoundly unjust to children whose lives are equally important.
A clean four-year CHIP funding extension and four years of funding for home visiting must be included in any final “doc fix” package. Certainly the price tag is not the obstacle. Funding for CHIP and home visiting for four years is expected to add up to less than $12 billion to serve millions of vulnerable children, a critical investment in the health of lower-income children.
Today, more than 8 million children depend on CHIP for health coverage. Together with Medicaid, CHIP has played a vital role in bringing the number of uninsured children to the lowest level on record. Simply put, CHIP is a bipartisan success story. But if funding is not extended quickly, up to 2 million children could become uninsured, and millions more would have to pay significantly more for less-comprehensive coverage. This would reverse the progress made over the past two decades and create a health coverage gap among children in working families. The vast majority of governors, both Democrats and Republicans, share our concerns about CHIP funds expiring abruptly. They are concerned about higher costs and inadequate benefits for children, budget challenges to cover children without CHIP, and an increase in uninsured children if CHIP funding ends.
The Children’s Defense Fund strongly supports a clean four-year extension of CHIP through 2019 because:
- The new health insurance exchanges need at least four years to make changes to ensure children have comparable pediatric benefits with costs to families no higher than in CHIP today. It is highly unlikely these improvements will be enacted and implemented by 2017.
- CHIP coverage saves money for states and the federal government. It is more efficient than private health insurance, costs less than subsidized exchange coverage and provides the comprehensive coverage that gives children and families access to the pediatricians, specialists and special facilities children need.
Four years of funding for the Maternal and Infant Early Childhood Home Visiting program is also a bargain. It brings quality home visiting to children and parents in every state and the District of Columbia and has bipartisan roots. Quality voluntary home visiting programs implement a two-generation strategy in which preschool children under age 5 and their parents benefit by being connected to community resources. MIECHV will end March 31 if funding is not extended. A four-year extension will allow states to expand their programs and reach many more children.
Rigorous research studies have found that quality, evidence-based home visiting programs produce measurable, long-term outcomes for children and families, including better health; greater school readiness, academic achievement, parental involvement, and economic self-sufficiency; and reduced child maltreatment, abuse, and juvenile delinquency.
Almost 80 percent of families participating in the MIECHV program had household incomes at or below 100 percent of the federal poverty line. As in CHIP, where states have flexibility to craft their programs, states that receive MIECHV funding can tailor their programs to serve the specific needs of their communities but have to meet certain benchmarks. Four more years of funding will enable important progress in meeting those benchmarks.
Congress must stop playing politics with children and pass four more years of funding for CHIP and MIECHV as part of the “doc fix” package if millions of children are not to be left with uncertainty and at greater risk. We need to ensure our children are healthy, supported, and strong if they are going to be able to support our growing number of seniors in the future. Congress must commit to this small but extremely important investment. About 30 years ago, CDF, AARP, the National Council on Aging, and the Child Welfare League of America established Generations United, an energetic organization today committed to improving the lives of children, youths, and older adults through intergenerational collaboration, public policies and programs for the enduring benefit of all. Its motto is “Stronger Together.” Four years of funding for both CHIP and MIECHV will help strengthen our children and help them support our older and aging generations.