The New Health Dialogue

The House and Senate health reform bills take very different approaches to the CHIP program and David Herszenhorn of the New York Times reminds us that the dispute over the Children’s Health Insurance Program "is not just a cerebral policy point.” 

Championed by Sens. John D. Rockefeller (D-WV) and Bob Casey (D-PA), the Senate bill would protect the CHIP program through 2019 and extend federal financing through 2015 (two years longer than under current law). The House would discontinue CHIP. Some of the children would be eligible for the expanded Medicaid program. Others would be able to get subsidized family coverage through the new health insurance exchanges. (Read details here).

“Attention must be paid to the possibility that some children who lose CHIP coverage could fall through the cracks and become uninsured,” Genevieve M. Kenney and Allison Cook wrote for an Urban Institute report last month. Between 2007 and 2008, the number of uninsured children decreased by 800,000 -- the number of uninsured children fell to the lowest level in a decade.

Some Democrats, including Rep. Henry Waxman (D-CA), argue that it will no longer be necessary to have a separate government insurance program for children once insurance subsidies are available to entire families. But many children’s health advocates explain that it is not so simple. 

For example, they fear that regardless of an individual mandate and the availability of federal health insurance subsidies, some low-income families will still find insurance unaffordable. (In the current system some low-income workers enroll their children in CHIP instead of purchasing employer-sponsored insurance because of its high cost.) Also, 14 percent of children that currently have government sponsored health insurance come from mixed immigrant status families. Illegal immigrants would not be eligible for government health insurance subsidies under either bill -- and their children would shoulder the consequences. 

Herszenhorn notes that the CHIP question relates directly to the Medicaid expansion provisions. The Senate would expand Medicaid eligibility to families and individuals earning up to 133 percent of the federal poverty level, the House to 150 percent. Medicaid, in theory, offers more comprehensive coverage than CHIP, but it can actually be more limiting because some doctors and other health care providers will not accept Medicaid's low reimbursement rates. The House bill would increase Medicaid payment for primary care physicians. The Senate bill does not. 

“The country has made remarkable progress in covering kids in recent years because of the success of CHIP and its companion program, Medicaid,” said Jocelyn A. Guyer, co-executive director of the Center for Children and Families at Georgetown University. “It would be a major problem if health reform undercut these gains by shutting CHIP down too abruptly or by moving kids into coverage that isn’t as affordable and as well-designed to get them the care they need to develop and grow.”