Since the Children’s Health Insurance Program was proposed by then-President Bill Clinton (with significant support from First Lady Hillary Clinton) and made law through the hard work of Senators Orrin Hatch and Edward Kennedy 20 years ago, the program has counted on and received support from both Republican and Democratic lawmakers. Originally created to insure children whose working parents didn’t have access to employer-based healthcare or Medicaid, the program was never overtly politicized because it demonstrably helped children and because it provided states with a great deal of autonomy, effectively allowing them to control how the program ran while taking advantage of federal money. Now, CHIP funding is becoming a hot-button political topic. Though short-term funds will likely keep the program going for the first several months of 2018, meaningful re-authorization has been put off by a Republican Congress consumed by priorities unrelated to children’s health.
Initially, the failure to re-authorize CHIP funding made parents and healthcare providers nervous — prompting a late-night scolding from Jimmy Kimmel. Now, that nervousness is turning to panic. Although Congress approved short-term funding, $3 billion dollars is not much in the context of American healthcare. Parents of children protected by the program can no longer reasonably count on it to serve as a safety net.
“Children’s health insurance coverage is at an all-time high in the United States. It’s actually a public health success story,” warns Dr. Lee Beers, Medical Director for Municipal and Regional Affairs of the Child Health Advocacy Institute at Children’s National Health System. “That’s something that could slip away from us.”
Beers, who is intimately acquainted with CHIP because many CNHS patients (and many of her patients) rely on the program, warns that a failure to reauthorize the program or a politicization of children’s healthcare could be a disaster on both a national and human level. She explained to Fatherly precisely why CHIP is such a critical resource for parents and why it’s so important that kids be insured.
If I didn’t know anything about what was happening with children’s healthcare right now, how would you describe it to me?
Most kids are insured through their parent’s employer-based healthcare plan. The next, largest group of kids are insured through Medicaid and the Medicaid expansion. The next group of kids are insured through CHIP, the Children’s Health Insurance Program. Each one of those avenues to access to care and access to insurance are an important piece of the puzzle. If you lose any one of those, you take a dramatic step back in terms of coverage.
Would it be accurate to think about the failure to fund CHIP as the tip of the iceberg, so to speak, in terms of deprioritizing children’s health care?
I think there have been a number of things that have made pediatricians and other child health care advocates concerned about children’s health being prioritized in the current Congress. Access to insurance doesn’t 100 percent ensure that a child is accessing quality care and stays healthy, but it is probably the first and most important step in making sure that happens.
If kids don’t have that open door to access quality healthcare, it’s putting their health at risk. Not just their physical health, but also their educational achievement, their long-term success, their long-term mental and emotional health. All of those things are tied to health care and adequate health services.
I know that the rumored next step is massive Medicaid cuts. If that happens, how quickly would that affect children?
Some of the earlier proposals for Medicaid block grants or Medicaid cuts were incredibly concerning. [They] really put a lot of children and families at risk for losing their access to health care.
It’s an investment that we should be making in our children, not just because it’s the right thing to do, but also because healthy children do well in school. Children who do well in school go on to do well in their lives and career and go on to be hardworking, productive, tax-paying citizens of our country. If we take a step back from investing in children’s health at these earliest stages, we’re really doing ourselves a disservice as a nation.
[What] people think less about is the types of services you may have access to. So the state is forced to cut Medicaid services. They may cut a number of beneficiaries. They may cut the number of people eligible for care. They may also cut the types of services available. That means that kids may not have access to full-well childcare services, things like hearing aids or other medical supports.
Right now, Medicaid coverage is based on a portfolio of benefits called EPSDT: “Early Periodic Screening Diagnosis and Treatment.” Those are really the gold standard for what we expect for health coverage for children.
Medicaid is at least touted as a political issue. CHIP was never a controversial program. Why is CHIP suddenly hard to fund? Why are politicians trying to put a band-aid on this thing?
I wish I knew the answer to that. I think there’s a number of things that make it so that CHIP should not be controversial. It has enjoyed bipartisan support from both parts of the Congress. It gives states a lot of flexibility in how they implement it. It provides health coverage largely to working families for their children.
It covers nine million children. The amount of money it takes to do that is really insignificant in the scheme of the overall budget of our country. This is an easy win for Congress, for children and families. It shouldn’t be a heavy-lift for Congress. Children and families are getting ready to lose coverage.
What is your organization, Children’s National Health System, doing to brace for a potential CHIP shutdown?
Many of our leaders, in collaboration with the Children’s Hospital Association and the American Academy of Pediatrics, have been stepping out there and speaking about the importance of this program for children and families. Children’s has a commitment to caring for all children, regardless of where they come from and what their insurance is — if they have insurance. We stand by that commitment, but CHIP is an incredibly important part of the network.
What can people who will be affected by CHIP not being reauthorized, or just care about children’s healthcare, do?
Contact your congressional representative and let them know it’s a priority to you. As constituents, that’s the way we make sure things happen. Also, spreading the message about CHIP and what CHIP is. Lots of people don’t really know what CHIP is or understand it.
[In] lots of states actually, their CHIP program has a different name. Sometimes people may not realize that the coverage they get through a particular program is CHIP. Social media is a great place to share that information. The American Academy of Pediatrics actually has fact-sheets for every state about CHIP programs and how many children are covered and what the details of the program’s financing and access are.
Children’s health is an incredible priority and needs to be an incredible priority for our nation. Congress [needs] to reauthorize CHIP as soon as possible, so we’re not putting families at risk of losing their health insurance.
The big bogeyman, of course, is the question of what will happen if CHIP isn’t re-authorized, and how real of a possibility it is that kids will go uninsured.
I don’t know. Last time this came up, I would have said, “Everybody loves CHIP! CHIP is a safe thing!” It doesn’t feel really safe right now. I think we have gotten reassurances that it will be passed. It’s important for it to happen, not just to talk about it happening. States are already having to invest resources into potential shutdown procedures for their CHIP programs.
If it’s not re-authorized, children are going to lose health insurance. Children of working parents. Children who have special health care needs. Children who otherwise don’t have good access to health care because for whatever reason their parents aren’t eligible for employer-based health insurance. When kids lose healthcare, they lose access to medication, preventative treatments. Those things make children sick. It puts them very much at risk.