Congress and CHIP: Why Children’s Health Insurance is at Risk

It has long been accepted that protecting vulnerable children is a worthwhile endeavor for localities, religious organizations, and state and federal government. Although all people are image-bearers of God, the innocence of children seems to set them apart as especially deserving of care. However, the widely-held belief that it is the responsibility of all of us to protect children is not always upheld the way it should be in policy and politics. On September 30, 2017 the Children’s Health Insurance Program (CHIP), an effective and historically bipartisan program, will run out of funding unless Congress reauthorizes the program’s budget. This incomprehensible threat puts the wellbeing of at least 8.9 million children at risk.

However, last week the Senate Finance Committee made a significant step towards protecting the health of millions of children. Senators Orrin Hatch (R-Utah) and Ron Wyden (D-Oregon) came together to announce an agreed upon five-year extension to CHIP’s funding. Part of the compromise is that federal matching rates, which were increased under the Affordable Care Act (ACA), will begin to be rolled back in 2020 and be completely eliminated in 2021. The full text of the proposed legislation has yet to be released at the time of this publication and once released will need to be approved by both houses of Congress and sent to the president. Moving forward, this vital safety net program’s prognosis, although not perfect, has improved considerably compared to where it stood a week ago.

Children’s Health Insurance Program (CHIP) Overview

CHIP is a federal-state partnership program that insures children of moderate- and low-income families with comprehensive health care. It was enacted in 1997 with bipartisan support as a way to fill a health insurance gap between Medicaid, the public health insurance program for low-income families and individuals, and the private health insurance marketplace. In both theory and practice, CHIP operates as a “step” for families as their household income fluctuates. The families that CHIP benefits have too high of an income to qualify for Medicaid, but do not have access or means for comprehensive, private coverage. Children covered by CHIP have increased access to primary and preventative care, including specialist and dental care, which contributes to a their ability to fully flourish.

CHIP is financed by both state and federal government, with the federal government providing a match to the state’s funding. Each state designs and operates its own program, deciding what model will work best for them. States utilize CHIP funding by creating a separate program, including it in Medicaid expansion, or creating a hybrid, “combination” program. Many states have chosen to create combination programs, rolling CHIP out in partnership and conjunction with their Medicaid programming.

CHIP plays a role in addressing systemic inequality in our healthcare system by making care more accessible for children who traditionally have limited access.

In Iowa, for example, the CHIP program is a combination program because the funding is used in Medicaid Expansion and also creates a separate program known as “hawk-i” (Health And Well Kids in Iowa).Hawk-i provides families who do not quite qualify for Medicaid and Medicaid Expansion the opportunity to enroll their children in either “full coverage,” which is health and dental insurance, or dental insurance, which supplements other health coverage. In May 2017, the federal government and state of Iowa helped families insure 42,946 children with full coverage and an additional 3,337 children with dental insurance. Furthermore, at this time no family pays more than $40 a month for full coverage.

Since 1997, the uninsured rate for children has fallen from 14% to an historic low of 5%. Nationwide, Medicaid and CHIP work together to provide coverage for nearly 2 in 5 children, covering 44% of children with special health care needs. Parents of children of color disproportionately report their children having less than excellent health, a lack of a usual source of care, and are more likely to do without care because of its cost than their white, non-Hispanic counterparts. Medicaid and CHIP work to address these findings, and cover over half of children of color. This helps demonstrate that CHIP works towards the long-term systemic impact of increasing access to health coverage, contributing to a decrease in health care and health outcome disparities among children. Furthermore, evidence suggests, unsurprisingly, that Medicaid and CHIP are connected with positive health outcomes as children, as well as future health, education, and financial gains.

Political Atmosphere and Implications

CHIP’s legislation is authorized through 2019, but Congress is responsible for reauthorizing the program’s federal funding, which was last reauthorized in 2015 for a two year period. In preparation for the program’s renewal, the Senate Finance Committee, which is chaired by one of CHIP’s original sponsors - Senator Orrin Hatch (R-Utah), scheduled a hearing to begin the program’s renewal process earlier this year. However, the hearing was postponed in the shadow of the House GOP’s American Health Care Act. As a result, CHIP’s looming fiscal deadline of September 30th was lost in the headlines. While CHIP’s future was uncertain in Congress, the Trump administration’s proposed 2018 budget recommended cutting CHIP’s funding by 20% and also made cuts to Medicaid funding, concerning many states, advocates, and families. Now in the aftermath of a failed “repeal and replace” bill and with the newly proposed funding legislation being considered along with a packed legislative agenda, there is some continued fear that the bitter partisan fighting will be refocused from the AHCA to CHIP’s funding renewal. Advocates are calling for a “clean” bill, requesting lawmakers refrain from adding on other controversial legislation to the CHIP reauthorization which could derail the approval process.

Congress and the president have limited time to finalize the bipartisan proposal to extend CHIP’s funding for five years. If Congress fails to approve CHIP’s funding proposal by the end of September, or if it cuts the program’s funding unexpectedly, it will be too late for states to adjust their budgets accordingly for this year. As a result of failing to reauthorize the program’s funding, every state will exhaust their program funding within the next year. Approving the proposed funding for CHIP means that a program that has empowered practitioners to offer care to virtually every child they encounter; a program that has provided comprehensive care to millions of children in the last 20 years, helped reduce class, race, and ethnic disparities in children’s health coverage, and laid the foundation for long-term physical, mental, and economic well-being; and a program that has been instrumental in bringing the rates of uninsured children to a historic low will be protected for the next five years. The welfare of at least 8.9 million children is dependent on it.

A Public Justice Perspective

Discussions regarding the functioning of government, stewardship of funding, and evaluation of programming are messy. However, engaging a public justice perspective demands entering into this mess to discern - to the best of our ability - the intended right roles and responsibilities of government and other involved institutions in promoting the flourishing of all people.

When considering the proper scope of government, the Center for Public Justice advises that government’s primary function is to promote the policies, practices, and programs that work towards the wellbeing of all, focusing on upholding and supporting the other institutions and spheres in fulfilling their responsibilities. The most fundamental institution woven into the fabric of creation is the family. Healthy, flourishing families provide nurture and care for children, creating a foundation for a healthy life. Upholding the flourishing of all families is a core responsibility of government, and is vital to a more just society. Additionally, CPJ reminds us that the calling to care for our hurting neighbors, including vulnerable families, is a calling addressed to all of us: “all people and all institutions.”

As Christian citizens, we should be vocal and consistent in our political engagement to support policies, practices, and programs that uphold healthy, flourishing families. CHIP encourages the flourishing and thriving of children and their families by supporting families with limited economic flexibility in fulfilling their responsibilities by making comprehensive health insurance for their children attainable.

CHIP plays a role in addressing systemic inequality in our healthcare system by making care more accessible for children who traditionally have limited access. Access is what makes CHIP imperative to the growth and flourishing of children and society overall. Eliminating CHIP would harm children in moderate- and low-income families. Additionally, the children hurt by these actions would be disproportionately children of color and children with special needs. While the recently announced bipartisan proposal from Senators Hatch and Wyden is a positive development, we must remain intentionally aware and actively concerned citizens. CHIP is a social safety net program that positive impacts the current health and wellbeing of all children, as well as their ability to flourish as adults. CHIP, in support with other social safety net policies and programs, contributes positively to our national community by supporting the flourishing of families, of children, and of society overall.

-Chelsea J. Maxwell is an advocate, learner, and social worker. She attended Dordt College and the University of Pennsylvania, and is passionate about the thriving and flourishing of all people.