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We've been talking a lot about two big deadlines for health care this month:
- September 27, the last day for insurers to sign their contracts to sell Obamacare plans in 2018 and the self-imposed deadline for any bipartisan stabilization bill in the Senate
- September 30, the day the special "budget reconciliation" privileges expire for Senate Republicans to repeal Obamacare with only 51 votes
But wait, there's more: Also on September 30, funding for the Children's Health Insurance Program expires. For reasons we do not have to get into, the money wouldn't just run out on October 1, but nevertheless, advocates have chided Congress for letting the deadline get this close without acting.
"This is ridiculous. It’s already too late," Joan Alker, executive director of Georgetown University's Center for Children and Families, told reporters at a briefing last week. "We have never had a situation like this before."
As a reminder, CHIP is a health insurance program created in the 1990s to sort of piggyback on Medicaid, and it provides coverage for kids in families with higher, though still lower-middle-class to middle-class, incomes. It is designed much like Medicaid, with states and the feds both contributing a share of the program's budget.
CHIP covers about 9 million children across the country and costs about $14 billion a year (the feds pick up about three-quarters of that cost). It is a smaller program than Medicaid and Medicare, of course, but it is still a big reason why we have nearly eliminated uninsurance among kids.
Up until this week, it looked like a distinct possibility that Congress would allow CHIP's funding to expire. While states would have some money left over to keep the program running for a matter of months, they had started preparing for the worst.
"We are in the process of developing a contingency plan of shutting down our separate CHIP program," Cathy Caldwell, who runs CHIP in Alabama, told us last week.
While some kids would be covered through Obamacare's marketplaces or their parents' work if CHIP shut down, she continued, "a fair amount of our children we think will become uninsured."
But this week, there was finally positive movement in Congress — though it comes with some catches.
Sens. Orrin Hatch (R-UT) and Ron Wyden (D-OR), the chair and ranking member of the Senate Finance Committee respectively, announced the outline of a deal to keep CHIP funded. It would:
- Extend CHIP's funding for five years, a big win for advocates who wanted a long-term extension
- Maintain Obamacare's enhanced CHIP federal funding for two more years and then start to phase it down to traditional levels. The 2010 law boosted the federal share by 23 percent — advocates knew that was unlikely to continue indefinitely but wanted a gradual phaseout to make sure states could adjust.
"They do have to give states some kind of ramp and time to plan," Bruce Lesley, who leads First Focus, said last week.
So the Hatch-Wyden deal gives CHIP advocates a lot of what they wanted: a longer extension and that off-ramp to lower federal funding for CHIP, not a cliff.
"I am really encouraged by this bipartisan progress which could break the logjam here in Washington and extend CHIP quickly," Alker wrote after the deal was announced. "This would be a victory for the peace-of-mind and economic security of families around the country who rely on CHIP for their children’s health coverage.
But that progress comes with three big caveats that could still trip things up before the end of the month:
- Hatch and Wyden haven't yet identified how they'll pay for their plan. Alker estimates they will need to find somewhere between $5 billion and $10 billion in offsets. That money has to come from somewhere.
- The House has to agree to it. The Energy and Commerce Committee is working on its own plan, and we don't yet know whether the lower chamber is amenable to such a long extension and the gradual phaseout of the enhanced Obamacare funding.
- Lawmakers could try to attach more controversial items — either Obamacare stabilization or repeal provisions — to the CHIP funding.
That last one is a big concern for advocates. The Wall Street Journal reported late last month that Republicans were looking at CHIP as a vehicle to either repeal some Obamacare taxes or fund the law's cost-sharing reduction payments.
If Senate Republicans and Democrats can agree to a bigger Obamacare stabilization plan, aides have said they think it would need to be attached a must-pass bill. Stabilizing Obamacare is too controversial on its own. With the debt limit raised and the government funded, there aren't many other candidates right now.
That's exactly what makes CHIP advocates nervous — that the program's funding could get stuck not because of any disagreements over CHIP itself, but because it becomes the cipher for a separate health care fight.
"CHIP is not and never has been a vehicle to drag controversial provisions across," Cindy Pellegrini, who works on federal issues for the March of Dimes in DC, said last week.
That might also explain why Senate leadership has been reluctant to set any firm timetable for taking up the CHIP extension. Hatch has said he doesn't want to see unrelated measures attached to the bill, but once the bill gets on the Senate floor, unexpected things can happen.
"If they put it on the Senate floor, how do they prevent amendments to it or prevent people from pursuing agendas?" Lesley said. "That’s what keeps leadership from even wanting to put it on the floor."
The clock is ticking, though. We're two weeks away from the deadline, and state officials are already preparing to send out notices on October 1 warning CHIP enrollees that their coverage could soon lapse.
The Hatch-Wyden deal is a positive step for the program. But Congress is, as ever, filled with land mines for even routine health care legislation.
Chart of the Day
CHIP is essential to covering kids. This gives you a further sense of how vital CHIP has been to driving the uninsured rate among children to 6 percent (for the non-elderly adults, by comparison, it's up around 15 or so percent). Two out of every five kids in America are covered either by CHIP or by Medicaid. Read more from the Kaiser Family Foundation.
Kliff’s Notes
With research help from Caitlin Davis
Today's top news
- “Trump is 'open' to ObamaCare fix, lawmakers say”: “President Trump was 'open' to the idea of a bipartisan ObamaCare stabilization bill but did not make any commitments during a meeting Wednesday with a group of House lawmakers, attendees said. The bipartisan group of lawmakers, known as the Problem Solvers, pitched Trump on their plan to stabilize ObamaCare markets.” —Peter Sullivan, the Hill
- “HHS slashes funding to some ACA navigator groups by up to 85 percent”: “Health and Human Services officials have informed grass-roots groups that assist with enrollment under the Affordable Care Act that their funding will be reduced by as much as 85 percent, a move that could upend outreach efforts across the country.” —Juliet Eilperin and Amy Goldstein, Washington Post
- “With time short and budgets slashed, Obamacare navigators go grassroots to spread the word”: “The people who put together Tennessee's open enrollment events and power the state's hotline are devising a last minute, grassroots strategy to let people know when and how they can buy individual health insurance.” —Holly Fletcher, Nashville Tennessean
Analysis and longer reads
- “Single-Payer Health Care Could Be a Tough Sell, Polling Shows”:“Single-payer health care, or as Sen. Bernie Sanders (I., Vt.) calls it, 'Medicare for all,' is becoming a rallying cry for many Democrats in Congress. But are Americans behind the idea of mandatory government-provided insurance?” —Joshua Jamerson, Wall Street Journal
- “Uproar builds over secret doctor panel that influences Medicare”:“Medicare has signaled it will rubber-stamp almost every 2018 payment proposal made by the American Medical Association's clandestine panel of doctors — raising the ire of numerous advocacy groups and primary-care doctors, who believe the federal government is bending to the will of the powerful medical lobby.” —Bob Herman, Axios
- “I’m the perfect person to price shop for an operation. But the process went terribly”: “My family had every advantage that newly minted price shoppers could possibly have: We live in Massachusetts, one of the states that have passed price transparency laws to help patients shop for care; I am a physician; my research focuses on consumerism and price transparency, giving me plenty of insider information; and the surgery was minor and not urgent, giving us lots of time to shop around. How did it go? Terribly. Here’s why.” —Ateev Mehrotra, STAT
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