Legislative action appears unlikely on the Children's Health Insurance Program during Congress' current lame duck session, despite ongoing pleas from advocates that federal funding for the program be extended as quickly as possible.
“I don't think we expect any movement on this before the end of the year,” said Andrew Wimer, spokesman for Rep. Joe Pitts, chairman of the House Energy and Commerce Committee's Subcommittee on Health.
States will get no new federal CHIP funding after September 2015 unless Congress acts. An estimated 10.2 million now are enrolled in the program. Of those, as many as 2 million may be unable to join either Medicaid or on an exchange plan should the program end, according to researchers.
“No matter what their views are on the Affordable Care Act, the reality is that if they (Congress) don't reauthorize funding, children will lose coverage,” said Jesse Cross-Call, a policy analyst in the health policy division of the left-leaning Center on Budget and Policy Priorities.
The Energy and Commerce Subcommittee on Health is hosting a hearing Wednesday to discuss the future of the program, calling on witnesses from the Congressional Research Service, Government Accountability Office and the Medicaid and CHIP Payment and Access Commission. The hearing will largely be informational in nature, however, based on the material outlined in the testimonies posted Tuesday.
Retiring Sen. Jay Rockefeller (D-W.V.), chair of the Senate Finance Committee's healthcare panel, agrees with advocates that urgent action is needed before Congress goes on recess later this month. He points out that many states are already putting together budgets for fiscal 2016 and so need to know if funding for CHIP will continue.
Also, states need to put plans into place as quickly as possible if they will be transitioning children into Medicaid or a qualified health plan if CHIP funding isn't extended, he said. “If Congress fails to act, CHIP will run out of funding next fall and jeopardize the well-being of millions of children and pregnant women. I remain hopeful that Congress will find a way to pass a CHIP extension – not only is this important to the health of our most vulnerable populations, it is vital to states as they budget for the future.”
Rockefeller released a bill in June to extend program funding for four years. A similar bill was introduced weeks later by Energy and Commerce Health Subcommittee Ranking Member Frank Pallone Jr. (D-N.J.), and Energy and Commerce Committee Ranking Member Henry A. Waxman (D-Calif.).
Neither bill has Republican co-sponsors, but advocates say CHIP has always enjoyed bipartisan support. The hearing Wednesday was scheduled by Republican staff members, according to the scheduling notice. Pitts has supported extending CHIP funding in the past.
Grace-Marie Turner, president of the Galen Institute, a conservative research organization, agreed that Republicans would agree to an extension, but likely for just two years versus the four years in the bills now circulating on the Hill.
The children most at risk of losing coverage altogether are those that fall into the so-called “family glitch,” a phenomenon in which a parent may have access to private insurance through an employer, but be unable to get insurance for his or her children.
The ACA dictates that premiums for individual coverage must not exceed 9.5% of a worker's income. But there is no limit on an employee's share of premiums for family coverage, which typically costs dramatically more than individual coverage. Without subsidies, families are currently forced to seek coverage for their children in public programs like Medicaid or CHIP.
Another issue is affordability because cost-sharing for CHIP is dramatically lower than if parents have to put their kids into a health plan. For instance, a family of four with an annual income of $50,085, or 210% of the federal poverty level for that family size, has average annual out-of-pocket costs of $97 through CHIP. That same family would face out-of-pocket costs of $926 under average marketplace plans, according to the bipartisan children's advocacy organization First Focus.
“We know that higher cost-sharing leads to the forgoing and delaying of care,” said Mara Youdelman, managing attorney of the National Health Law Program.
CHIP, which covers children in families earning up to 200% of the federal poverty level, has substantially expanded children's coverage since its creation in 1997. Federal spending for the program was $13 billion in fiscal 2013, up 8% from the previous year.
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