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Source: KFF Issue Brief, Rudowitz, Artiga and Arguello, March 2014
Source: KFF Issue Brief, Rudowitz, Artiga and Arguello, March 2014

Last weekend, the GOP-controlled House quietly defunded the Children’s Health Insurance program (CHIP) by refusing to reauthorize it, threatening the health care of approximately 8.9 million American children. If you watch traditional media, you likely missed this story, as it has been criminally under-covered, if not totally eclipsed by other stories (e.g. Trump’s tweets against Puerto Rican politicians).

While congress couldn’t find the $10 billion required to fund CHIP, two weeks ago it managed to find $700 billion to fund the Pentagon, including $80 billion in new spending. This appalling contrast is an indictment of our government’s priorities and brings to mind the old Dwight Eisenhower, 1953, Chance for Peace Speech, Washington D.C., quote:

“Every gun that is made, every warship launched, every rocket fired, signifies in the final sense a theft from those who hunger and are not fed, those who are cold and are not clothed.” 

In order to fix this injustice, people need to be informed about what just happened so that they can put pressure on their representatives to reauthorize CHIP.

What is the CHIP Program and Why Does it Matter?

The CHIP program was enacted in 1997 as part of the Balanced Budget Act of 1997 and is designed to provide healthcare to children in families that are too poor to afford private coverage, but don’t qualify for Medicaid. It costs approximately $10 billion per year and covers 8.9 million children. Each state has flexibility in how it allocates CHIP funds and can set different coverage requirements (e.g. 46 states cover children at 200% of the poverty line, while 24 expand coverage to higher income families), but there are federal guidelines to ensure that all state program focus on the central goal of increasing coverage for children. In addition to providing care for children, CHIP can be used to provide care for pregnant women, promote vaccination, and fund dental health programs aimed at children.

Given its purpose, one would think that CHIP would be essentially unassailable from a political perspective—it exists solely to provide care to vulnerable children and incorporate a high level of state control to placate the right wing and avoid accusations of a federal takeover of healthcare. In the past, this has largely been the case and it has been reauthorized four times in the last 20 years. Sadly, the level of dysfunction in the legislature has grown in recent years, and, on September 30th, they failed to meet the deadline for reauthorization.

Because CHIP has a rollover provision, which lets states use money that they didn’t spend in the previous year in the next year’s program, the immediate impacts of this failure to reauthorize the program vary by state—here is a complete list that tells you when your state will run out of CHIP funding. By March 2018 a majority of states will run out federal funding and by June, every state but Wyoming will run dry.

The loss of federal funds will cascade down to the states, putting them under massive financial pressure to make up for CHIP funding deficits or, more likely, scale back their program. This will continue downstream to families, who will be forced to pay larger out of pocket costs to access CHIP coverage, or will be kicked out of the program entirely and forced to find private coverage.

The real-life impact of this will be millions of children losing access to their healthcare and being put at risk. Not only will children be unable to access care for diseases and injuries, but they won’t be able to access screening and diagnostic programs that help catch significant disorders early (e.g. diabetes, asthma, mental health issue, etc.). Because diagnosing and treating diseases in children early can help reduce their severity and costs in the long run, these disruptions in CHIP will have long-term impacts on many children’ health and care costs.

The impacts of CHIP reductions will not be felt uniformly across all groups. Analyses of the CHIP and Medicaid populations indicate that African American and non-white Hispanic children rely on CHIP at nearly twice the rate that white and Asian children do (Black: 56%; Hispanic: 52%; White: 26%; and Asian 25%). This means that cutting CHIP will have a disproportionate racial impact that will put most of the burden on communities of color.

Conclusion

Unless a reauthorization of CHIP is passed, millions of American families will be negatively impacted and millions of children will lose access to affordable healthcare. This is a completely self-inflicted injury, caused by political factors that have no bearing on the effectiveness of the program. There is broad agreement that CHIP is effective from both sides of the political spectrum—it was reauthorized in 2015 by a vote of 392 to 37 in the House and 92 to 8 in the Senate—and no valid reason why it shouldn’t be immediately reauthorized.

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