Funding fight puts 1M Texas kids at risk
Without quick action, low-income families’ coverage could lapse
WASHINGTON — Children’s health advocates are worried that lawmakers’ different ideas about how to fund a federal insurance program will leave nearly 1 million Texas children without coverage.
House and Senate committees each approved bills last week to renew the Children’s Health Insurance Program, which expired Sept. 30, for five years. Most states have leftover CHIP funds, but three — Arizona, Minnesota and North Carolina — plus the District of Columbia expect to run out by December. Last week, the Texas Health and Human Services Commission estimated that the state program would run out of funding in January instead of February, in part because of demands following Hurricane Harvey.
CHIP covers 9 million kids nationwide whose families make just above the threshold to qualify for Medicaid. If Congress doesn’t renew the program quickly enough, kids on CHIP could see a sudden lapse in coverage, leaving many low-income families to fend for themselves on the insurance market.
Susan Garnett, CEO of the My Health My Resources mental health center in Tarrant County, said more than 80 percent of the center’s child patients are covered under CHIP or Medicaid.
“CHIP in particular is a resource for working families that don’t have access to insurance for their children,” she said. “It provides a great opportunity to help people get insurance, people who are already helping themselves.”
The federal government pays 92 cents of every CHIP dollar in Texas. That’s higher than in recent years because of a 23-cent boost under Obamacare that will phase out by 2021.
Lawmakers in both parties support funding CHIP. Sen. John Cornyn compared the Senate’s approach to renewing the program to a GOP proposal for replacing the Affordable Care Act that failed last month. It would have given states block grants, or lump sums of money, to devise their own health care systems, which is how CHIP is structured.
“It’s a good example of how providing states with flexibility and resources in the form of block grants can be successful in improving health coverage and outcomes,” he said.
The sticking points between the House and Senate come down to how to fund it.
The Senate version does not suggest cuts elsewhere in the federal budget to cover the cost of CHIP. The House bill would allow states to push payment for prenatal and pediatric care to other insurance that Medicaid recipients may have, a practice called thirdparty liability. States currently cover such costs and bill insurers later to make sure care and payment move quickly.
The House bill would also drop Medicaid recipients who win a lottery jackpot of at least $80,000 and raise Medicare premiums for seniors earning over $500,000.
Rep. Michael Burgess, chairman of the Energy and Commerce subcommittee on health, defended the cuts Wednesday.
“Is it OK for someone who wins a massive amount of money in the lottery to still draw on Medicaid if they were on Medicaid before? They may not need a public assistance program any longer,” he said.
The Medicare cuts would affect only the few seniors lucky enough to have “a pretty big earnings package,” Burgess said, and requiring care providers to collect from private insurance before Medicaid is just part of the job.
“I was a provider. I had to bill Aetna, United, Cigna,” and other private insurers, he said, citing his career as an OB-GYN. “Yes, they can be a pain in the neck to collect from. But that’s part of what you do, that’s what your office is geared to take care of.”
During the House’s review of the bill last week, Arlington Rep. Joe Barton, vice chairman of the Energy and Commerce Committee, also said the cuts are reasonable.
“They’re not rocket science. We aren’t cutting back any major program,” he said. “It’s a good thing that we offset the spending.”
Experts weigh in
But child health advocates across the political spectrum are wary of cutting other health care programs, which could slow the renewal process.
“Obviously most advocates are not going to be in support of paying for children’s health insurance with something that takes money away from some other vulnerable group or some other health care program,” said Anne Dunkelberg, director of the Health and Wellness Program at the left-leaning Center for Public Policy Priorities in Austin.
Deane Waldman, director of the Center for Healthcare Policy at the right-leaning Texas Public Policy Foundation, saw the proposed cuts as distractions.
“In the past, [CHIP] has been funded rather than approached as a revenue-neutral activity,” he said. “Congress has funded it, period.”
Waldman said he worries that letting states put off payment for prenatal and pediatric care could push providers from Medicaid because they might not be paid as consistently.
“Anything that deters or reduces prenatal care is bad money management, as well as what really matters, bad medical care,” he said.
Waldman supports more check-ins to make sure registered welfare recipients are still eligible. But he said that Medicaid would save little from kicking off lottery winners, and that it isn’t fair to take funding from Medicare seniors to cover CHIP kids when both groups need it.
Should the House and Senate pass the bills, having to reconcile their differences could push CHIP renewal into a catch-all spending package that Congress plans to tackle in December.
But that may be too late for some states. Minnesota has received $3.6 million to tide the state’s CHIP program over until the end of October, and Utah filed an amendment in September to start cutting eligibility and benefits as funding runs out.
The Texas CHIP program would need at least a month to warn recipients and prepare a phase-out, Dunkelberg said.
“If they don’t get this going before the end of the year, and preferably November, we could have some real problems,” she said.