Time to stop using 9 million children as a bargaining CHIP

January 19, 2018 by Simon Haeder, The Conversation
Funding for the Children’s Health Insurance Program (CHIP) has run out. Credit: stockcreations/shutterstock.com

Since the inauguration of President Donald Trump, health care has been front and center in American politics. Yet attention has almost exclusively focused on the Affordable Care Act and congressional Republicans' slew of attempts to repeal and replace it.

These efforts, combined with a variety of other steps taken by the Trump administration, have increased the number of uninsured Americans by more than 3 million since last January.

With Congress so preoccupied, little attention has been paid to a bipartisan program that has been in place since the late 1990s: the Children's Health Insurance Program. Often referred to simply as CHIP, it provides health coverage to 9 million American children whose families earn too much to qualify for Medicaid but cannot afford .

Funding for CHIP ran out at the end of last September, leaving both state governments and families with great uncertainty. So far, congressional Republicans have refused to offer a clean renewal of CHIP, but have consistently raised demands to undermine the ACA in return. Their latest measure offers to fund CHIP in exchange for avoiding a government shutdown and a deal with Democrats over Dreamers.

Holding 9 million and their families as bargaining chips has gone on much too long.

What is CHIP?

Since its creation by a bipartisan coalition under the Clinton administration, CHIP has been crucial for the health of millions of American children, their families and their communities. It has also proven tremendously popular with families and their doctors, as well as with state and federal level policymakers.

CHIP fills in the gap for those children who fall just above the Medicaid threshold, determined by family income, but still do not have access to affordable, employer-sponsored insurance. Almost all CHIP children live in households where at least one parent works. Ninety percent live in households that are 200 percent below the federal poverty line.

At cost of just below US$14 billion, CHIP, together with Medicaid, has been crucial in ensuring that more than 95 percent of American children are covered by health insurance today. This compares to 89 percent at the time the program was created.

States have a significant amount of flexibility in terms of eligibility levels, benefit design, copayments, premiums, enrollment and administrative structure. At the same time, the financial contribution of the federal government is significantly above what's offered for Medicaid, making participation particularly enticing for . Not surprisingly, with large amount of flexibility and generous financial support, states have long looked favorably toward the program.

Yet CHIP, unlike Medicaid, is not an entitlement but rather a block grant. As a block grant, CHIP requires periodic appropriation of funding to maintain the program.

Why is CHIP so important?

The benefits for families and communities of CHIP are many. CHIP is crucial in providing financial security, preventing families from suffering catastrophic losses.

Moreover, the program does a tremendous job at ensuring that children's health needs are met comprehensively. Healthier children are more likely to attend school and graduate from high school and college. Healthier children also prevent parents from forgoing their own care or missing time at work.

CHIP also serves a large number of children with special and costly needs, such as ADHD and asthma.

The crucial role of CHIP has been repeatedly emphasized by health policy experts. Not surprisingly, MACPAC, the commission that provides Congress with advice on Medicaid and CHIP, recommended last January to continue and further enhance the program.

How should we move forward?

Between the Medicaid expansions of the 1990s, the creation of CHIP and the ACA, America has made great strides in providing to its most vulnerable, including America's children. Indeed, insurance enrollment rates for children are at historic highs, hovering around 95 percent. Congressional inaction has endangered these historic gains.

Since funding ran out in September, Congress provided a limited lifeline by providing temporary funding to states. Similarly, the Department of Health and Human Services has been able to reallocate funding to those states most in need. Yet, without further Congressional action, almost half the states expected to run out of funding in February.

Already, states have been confronted with daunting challenges on how to possibly maintain or phase out the program. Several states will automatically terminate their programs if federal funding for the program falls below a certain threshold. Moreover, state budgets have assumed that the program will continue in its current form. Failure to reauthorize the at current levels would pose tremendous problems for all states.

The continuing resolution introduced by congressional Republicans the week of Jan. 15 once more attempts to bargain CHIP for further erosion of the ACA by suspending or delaying several of its tax provisions. Ironically, Republican efforts to undo the ACA are expected to drive up premiums in the insurance markets so much that renewing CHIP for 10 years would likely save the federal government money.

Yet, even at the current cost, I firmly believe CHIP is a tremendous bargain. Its great benefits allow children to reach their potential. It's time for Congress to get their act together and pass a stand-alone long-term renewal of CHIP.

Explore further: As CHIP money runs out, millions of U.S. kids may lose health care

Related Stories

As CHIP money runs out, millions of U.S. kids may lose health care

January 12, 2018
(HealthDay)—Time is running out for millions of American kids covered by the Children's Health Insurance Program (CHIP).

Health care fallout: Fate of 8M low-income children in limbo

December 1, 2017
TC Bell knows what life is like without health insurance after growing up with a mother who cobbled together care from a public health clinic, emergency room visits and off-the-books visits to a doctor they knew.

More than eight million children could face higher insurance costs without CHIP

April 3, 2017
More than 8 million children enrolled in the Children's Health Insurance Program (CHIP) could be at risk of losing coverage if federal funding for the program is not extended this year. Children with chronic conditions are ...

New grants will help get health insurance for more kids

July 2, 2013
(HealthDay)—More children in low-income families will get health insurance coverage, thanks to nearly $32 million in grants announced by U.S. health officials Tuesday.

Kids with Medicaid, CHIP get more preventive care than those with private insurance

November 16, 2015
Children insured by Medicaid or the Children's Health Insurance Program (CHIP) were more likely to get preventive medical and dental care than privately insured children in a study that compared access and use of health care ...

Nearly 1 million more kids have health coverage after Obamacare

May 11, 2016
(HealthDay)—Nearly 1 million U.S. children gained health insurance the first year after the Affordable Care Act—also called Obamacare—was fully implemented, a new report shows.

Recommended for you

Juul e-cigarettes pose addiction risk for young users, study finds

October 19, 2018
Teens and young adults who use Juul brand e-cigarettes are failing to recognize the product's addictive potential, despite using it more often than their peers who smoke conventional cigarettes, according to a new study by ...

Adding refined fiber to processed food could have negative health effects

October 19, 2018
Adding highly refined fiber to processed foods could have negative effects on human health, such as promoting liver cancer, according to a new study by researchers at Georgia State University and the University of Toledo.

Self-lubricating latex could boost condom use: study

October 17, 2018
A perpetually unctuous, self-lubricating latex developed by a team of scientists in Boston could boost the use of condoms, they reported Wednesday in the journal Royal Society Open Science.

How healthy will we be in 2040?

October 17, 2018
A new scientific study of forecasts and alternative scenarios for life expectancy and major causes of death in 2040 shows all countries are likely to experience at least a slight increase in lifespans. In contrast, one scenario ...

Adequate consumption of 'longevity' vitamins could prolong healthy aging, nutrition scientist says

October 16, 2018
A detailed new review of nutritional science argues that most American diets are deficient in a key class of vitamins and minerals that play previously unrecognized roles in promoting longevity and in staving off chronic ...

Study finds evidence of intergenerational transmission of trauma among ex-POWs from the Civil War

October 16, 2018
A trio of researchers affiliated with the National Bureau of Economic Research has found evidence that suggests men who were traumatized while POWs during the U.S. Civil War transmitted that trauma to their offspring—many ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.