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Congress is already doing real damage to CHIP

“A fair amount of our children we think will become uninsured.”

Pediatric patient John Moore/Getty News Images
Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

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Nearly two months since its funding technically expired, the Children's Health Insurance Program is still in limbo while congressional Republicans try to pass their tax bill.

There was a lot of good reporting over the past week about how states are preparing for the possible end of funding for CHIP, which covers more than 9 million Americans.

Then on Monday, Colorado announced it would start sending letters to families enrolled in CHIP, letting them know what their options would be if the program actually ran out of money. The state projects its reserves for CHIP, which helps cover 167,000 people there, will be dry at the end of January.

States warned us this would happen if Congress left the matter unresolved. Some families might be able to buy coverage on their state's Obamacare marketplaces, as Colorado is notifying its residents, but the fear is that some number of children would become uninsured.

"A fair amount of our children we think will become uninsured," Alabama CHIP director Cathy Caldwell told reporters earlier this fall. The program helps cover 150,000 kids in her state.

With the stakes so high, most people in Washington still believe Congress will act to fund CHIP next month, as a slew of must-pass bills come up on the House and Senate floors. CHIP shouldn't go unaided forever.

But lawmakers could still be doing real damage to the program.

Florida learned this lesson about a decade ago, Steve Freedman, a University of South Florida health policy professor who sits on the CHIP board there, told me recently.

They call it the “CHIP dip.”

In 2003 and 2004, the state enacted new restrictions on CHIP enrollment. Enrollment declined. Then Florida officials decided in 2005 they'd made a mistake. The program's rolls had shrunk from 337,000 and kept falling to less than 200,000 at their lowest point.

The state took steps to expand enrollment again. But it took years to bring people back into the program, and even in 2010, CHIP enrollment was still significantly lower than it was before the state's initial rollback, just a little more than 250,000.

CHIP enrollment in Florida

Freedman said people in the state attributed that prolonged depressed enrollment to the uncertainty around the program in those years more than any specific policy change.

Not unlike what states are experiencing now while Congress drags its feet funding CHIP.

"Every time one of those kinds of things happens, we have to retool our relationships with families," he told me. "When you start fiddling with people’s economic security, particularly their children’s health care, that’s really a sensitive place to screw around."

Quote of the Day

"Increasing the debt now for economically dubious — and undoubtedly regressive — gains could threaten Social Security and Medicare in the not-so-distant future."

Melissa Favreault, Urban Institute

This is not a populist tax bill. The tax overhaul that is distracting Republicans while CHIP goes unfunded means more for health care than even VoxCare readers might appreciate. In the long run, if the deficit rises as projected under this bill, Congress is going to face more pressure to cut spending on Social Security and Medicare. Melissa Favreault went through the issue in this excellent Urban Institute piece.

Kliff’s Notes

With research help from Caitlin Davis

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  • “Heated And Deep-Pocketed Battle Erupts Over 340B Drug Discount Program”: “A 25-year-old federal drug discount program has grown so big and controversial that it faces a fight for survival as federal officials and lawmakers furiously debate the program’s reach. The program, known as 340B, requires pharmaceutical companies to give steep discounts to hospitals and clinics that serve high volumes of low-income patients.” —Sarah Jane Tribble, Kaiser Health News

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