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Without CHIP resolution, 1.7 million kids could lose healthcare in weeks

by Phil McCausland /
Image: A pediatrician examines an infant's ear in Takoma Park, Maryland, on April 8, 2015.
A pediatrician examines an infant's ear in Takoma Park, Maryland, on April 8, 2015.Andrew Harrer / Bloomberg via Getty Images

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More than 1.75 million children in 20 states and Washington, D.C., are at risk of losing their health insurance by the end of February if Congress does not reauthorize the Children’s Health Insurance Program, which ceased being funded when lawmakers failed to pass a spending bill late Friday night.

As the weekend continues, Congress is attempting to negotiate a deal that would provide CHIP a six-year extension, but that's not soon enough for some.

“I’m tired of my daughter's health being used as a political weapon," said Lisa Nunez, a resident of Port Jefferson, Long Island, whose 11-year-old daughter is a CHIP recipient.

By March, 20 states and Washington D.C. will likely have run out of money for their federally-funded CHIP programs. That could leave 1.7 million kids without health insurance starting in March.
By March, 20 states and Washington D.C. will likely have run out of money for their federally-funded CHIP programs. That could leave 1.7 million kids without health insurance starting in March.Phil McCausland / Georgetown University Health Policy Institute/MACPAC

Nunez's daughter is part of that initial wave of children who are expected to lose insurance if Congress does not make a deal on the program, but 24 other states will likely run out of the block grant funding for their separate CHIP programs soon thereafter, according to the Georgetown University Health Policy Institute.

The health care program covers around 8.9 million American kids overall. The situation is most dire for the nearly 3.7 million who get their insurance through their state's separate CHIP programs, rather than CHIP-funded Medicaid. A provision in the Affordable Care Act stipulates that children who receive health insurance through CHIP-funded Medicaid cannot lose their insurance even if that CHIP funding were to disappear.

The Health Policy Institute said that 10 states — Arizona, Connecticut, Florida, Hawaii, Louisiana, Minnesota, Nevada, New York, Ohio and Washington — and Washington might have to shut down their programs on Feb. 1, less than two weeks from Friday. Via CHIP programs, those states provided nearly 800,000 children with health care in 2016, according to the Medicaid and CHIP Payment and Access Commission.

Related: The government is shut down. What happens now?

But the speed at which children will lose their coverage is still only an estimate. The true pace of the fallout from an unfunded CHIP program is unknown because something like this has never occurred.

“There are many, many questions, and it’s very troubling that we’ve gotten to this point,” said Joan Alker, the executive director of the Center for Children and Families at Georgetown University. “It’s an unprecedented situation. I’ve been working on CHIP since it was born in 1997, and I’ve never seen anything like this before. It’s very sad.”

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The concept of reauthorizing the program, beyond a temporary measure, has languished in the Republican-controlled Congress through the entirety of 2017. A tentative bipartisan agreement came to fruition in September, sponsored by one of the CHIP program's original architects, Sen. Orrin Hatch, R-Utah, but the “KIDS Act of 2017” — which would have funded CHIP through 2022 — was put on the back burner by congressional leadership in favor of tax reform and repealing the Affordable Care Act.

The short-term spending bill passed in the House on Thursday would have reauthorized the program for six years, largely following the blueprint of Hatch’s KIDS Act. The bill required 60 votes in the Senate and was ultimately shot down.

It would be the fourth time Republicans have passed a short-term spending bill since the start of the fiscal year in October. Democrats and some members of the GOP have lost their patience.

“I think we’re not going to get a [continuing resolution] through the Congress until we have a pathway forward to increase defense spending, deal with immigration, CHIP and everything else,” Sen. Lindsey Graham, R-S.C., said Thursday.

Image: A pediatrician examines an infant's ear in Takoma Park, Maryland, on April 8, 2015.
A pediatrician examines an infant's ear in Takoma Park, Maryland, on April 8, 2015.Andrew Harrer / Bloomberg via Getty Images

Federal funding for CHIP officially expired on Sept. 30 of last year. As states began to run out of money — with 16 states initially preparing to burn up the last of their federally allotted cash by the end of this month — Congress passed a continuing resolution in December that provided states $2.85 billion. But that short-term cash will fizzle out soon, leaving millions of kids across the country without health care.

The loss of the program is expected to be costly for families as well as the federal government.

According to the Congressional Budget Office, reauthorizing CHIP would be a thrifty move for the government, especially after the new tax plan removed the individual mandate from the ACA.

The CBO score released last week concluded that the KIDS Act, which is included in the House-passed short-term spending bill, would cost the government a total of $800 million over the next five years.

Related: Congress, pointing fingers, fails to resolve shutdown stalemate as clock ticks on

A 10-year extension, however, would actually lead to the government saving money “because the federal costs of the alternatives to providing coverage through CHIP (primarily Medicaid, subsidizing coverage in the marketplaces, and employment-based insurance) are larger than the costs of providing coverage through CHIP during that period,” the report said. It would also allow states to take greater control of the costs associated with CHIP down the line.

Whatever deal is made, Democrats aren’t expected to be held responsible if the child’s health care program goes unfunded.

“Congressional leadership will have a hard time convincing people that Democrats are to blame when Republicans are in control of Congress,” said Alker.

“It would have been responsible to do this a year ago,” she added. “And that wasn’t a secret then.”

The decision to put off CHIP could prove to be quite costly for the GOP in the 2018 midterm elections, which creep ever closer.

A Kaiser Family Foundation poll in November found that a whopping 62 percent of people believe that reauthorizing CHIP funding should be the top legislative priority for President Donald Trump and Congress in the coming months, beating out stabilizing Obamacare, tax reform or creating new immigration policies.

“It’s so crazy,” Alker said. “I never thought we would get to this point. And now with the specter of a government shutdown looming, that just adds another layer of uncertainty.”

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