About 400,000 Texas children and thousands of pregnant women are in danger of being tossed from their health coverage for no good reason — other than Congress is dragging its feet in reauthorizing the hugely successful Children’s Health Insurance Program (CHIP).
By late-December, state health officials will send families letters informing them they will lose CHIP coverage by about the end of January if Congress doesn’t reauthorize CHIP or contingencies aren’t rolled out. At that point, Texas kids will be left in the lurch.
Such inaction amounts to political malpractice, given the stakes: the health and welfare of 9 million kids across the nation whose parents are working but earning too little to afford private health insurance. Those families earn too much to qualify for Medicaid, the federal health insurance program for the poor, so CHIP fills that gap and has done so successfully for 20 years.
“I have patients on CHIP scheduled into the new year who currently have no idea those appointments could be canceled without Congressional action,” said Dr. Joyce Mauk of Fort Worth. “Some of those appointments are routine and preventive, but many others are for children with complex medical conditions and special health care needs. Those children absolutely can’t go without their CHIP coverage.”
Also in danger are 36,000 Texas women who are pregnant, mostly immigrants who stand to lose prenatal coverage. Texas, besides being first in the nation in the number and percentage of people without health insurance, also has the dubious distinction of being one of just six states that exclude documented immigrant women from Medicaid maternity care, according to the Center for Public Policy Priorities.
Just to be clear, we’re talking about women who are in the country legally. They have their green cards. Their children, when born, will be U.S. citizens. The same is true of children born in the country to undocumented mothers, also excluded from Medicaid. CHIP’s prenatal health coverage is considered critical for that group of mothers in giving birth to healthy babies, so that is another gap CHIP is filling in the state’s health care system.
Though Texas and other states run their respective CHIP programs, they are financed mostly with federal dollars. For instance, Texas’ budget for the 2018-19 biennium is based on a federal matching rate of 93 cents for each CHIP dollar. That is estimated to total about $3.2 billion in federal CHIP funds for fiscal years 2018 and 2019.
The failure by Republican House and Senate leaders to get their bills passed by both chambers, resolve differences in the proposals and send legislation to President Trump to sign cannot be explained by mere partisanship — because the program is popular on both sides of the aisle and with the public. Therefore, their procrastination is intentional.
Consider that about three-quarters of the public — and majorities across parties — said it was important to reauthorize the Children’s Health Insurance Program, according to a September poll by the Kaiser Family Foundation.
Popularity aside, CHIP has proved successful in doing what it is supposed to do: provide health coverage for children of lower-income working parents in a cost-effective way that benefits taxpayers.
It has helped lower the uninsured rate for children across the nation to 5 percent in 2016, according to Kaiser. That is a huge drop from 1997, when CHIP was established. Then the uninsured rate for children was 14 percent.
CHIP also is credited with similar drops in the portion of uninsured children in Texas, from about 18 percent in 1998 to 6 percent in 2015 among children eligible for CHIP, according to the Texas Health and Human Services Commission.
The program also has helped communities manage costs.
“When you provide primary care for children, you are providing access to preventative care as well,” said Lance Lunsford, a spokesman for the Texas Hospital Association. “Kids get the care they need in a doctor’s office or free-standing clinic in lieu of need to visit an emergency room, where ultimately the cost of care is going to be higher.”
He noted that the program has enjoyed bipartisan support in part because families typically make co-payments for CHIP coverage for their children.
Texas health officials say they have no reason to believe CHIP won’t be reauthorized before running out of money — and that might be the case if CHIP funding is included in spending plans expected to move through Congress this month. It’s worth noting that the House has passed a CHIP bill, but not the Senate. Measures under consideration would extend federal CHIP funding for five years.
Nonetheless there are no guarantees. Clearly child advocates, pointing to a Congress that allowed CHIP to expire Sept. 30 — though many states still have money to operate the program — are worried. With the clock ticking, Texas advocates are turning up the pressure to get something done.
Dozens of groups, including the Texas Hospital Association, sent a joint letter to Texas U.S. Sens. John Cornyn and Ted Cruz and Gov. Greg Abbott expressing their concerns and the need to re-authorize CHIP funding as soon as possible. Other groups that signed on include the Texas Dental Association, Texas Medical Association, Texas Pediatric Society, Texas Chapter of the American Academy of Pediatrics, and March of Dimes Texas.
They emphasized that waiting to resolve CHIP funding until the end of the year will have dire consequences, including potentially disrupting CHIP coverage.
They are right. Time, money – and excuses — are running out. Holidays are approaching. Waiting until the last moment to extend CHIP funding creates an unnecessary strain on families in Texas and elsewhere for a government program that is popular, efficient and bipartisan.