Future of insurance program for children uncertain
Oklahoma pediatricians are urging Congress to quickly reauthorize a health insurance program for children before it expires in September potentially costing the state $49 million.
Congress created the Children’s Health Insurance Program in 1997 to expand health insurance to children in families who earn too much to qualify for Medicaid. Its latest extension will expire on Sept. 30 if Congress doesn’t act.
States receive a federal block grant and have some latitude in running their CHIP programs, so long as they commit their own money as matching funds, according to the Center for Children and Families at the Georgetown University Health Policy Institute. In Oklahoma, CHIP covers children in families earning up to 210 percent of the poverty line, or $51,660 for a family of four.
If Congress doesn’t act, Oklahoma would still receive some federal funds for CHIP through Medicaid, but the rate would be lower, according to the National Academy for State Health Policy. The Oklahoma Health Care Authority estimated getting payments at the lower rate would cost the state about $49 million through July 2018.
The Oklahoma Health Care Authority thinks it can fill the gap this year by pushing three weeks’ worth of payments to medical providers from June 2018 to July, when a new fiscal year will have started. If Congress doesn’t reauthorize CHIP, the Oklahoma Health Care Authority will work with other state leaders to determine whether they need to make more changes to the program, according to an agency news release.
“While we’re watching federal activities closely, we remain cautiously optimistic that we will be able to sustain our programs this fiscal year,” agency CEO Becky Pasternik-Ikard said.
Dwight Sublett, a Stillwater pediatrician and vice president of the Oklahoma chapter of the American Academy of Pediatrics, said the uncertainty over CHIP comes at a time when Oklahoma doctors already are worried about their ability to serve patients.
The Legislature will have to fill a $215 million budget hole after the state Supreme Court struck down a cigarette “fee” as an unconstitutional tax increase. The concern is that the Legislature could decide to allow deep cuts to Medicaid rates to fill the gap, he said.
If reimbursement rates fall again, primary care doctors may have to limit their Medicaid and CHIP patients, Sublett said. If that happens, parents may take their children to emergency rooms or urgent care clinics, which are more expensive than office visits, he said.
“The problem is that the patients, the children, are still here and have to be cared for,” he said. “If you can’t access care early, the problem is going to become worse.”
Children with complicated conditions would be most at risk, because sporadic care in an emergency room won’t be enough, Sublett said. Doctors and hospitals likely would try to serve those children, but they might not be able to take as many at a time, forcing longer waits if a family can’t pay.
“Physicians want to treat the patients, but there comes a break point,” he said.
In previous years, CHIP reauthorization passed by wide margins. Some House leaders have signaled they aren’t in a hurry to pass a bill this year, however. STAT News, a Boston Globe website focused on health, reported House Energy and Commerce Committee Chair Rep. Greg Walden, a Republican from Oregon, said Congress will have some cushion because most states have saved some CHIP funds that could allow them to keep making payments after the current authorization expires.
Congressional Quarterly reported Rep. Tom Cole, a Moore Republican, is optimistic states won’t have to wait long for an extension.
“I think, hopefully, we get it done by the end of September,” Cole told
Congressional Quarterly in early August. “We should try to get it done within the fiscal year, but if not, we’ll pass a shortterm extension and certainly get it done this calendar year.”
Other members of Oklahoma’s Congressional delegation expressed support for continuing the CHIP program. Sen. James Inhofe, a Tulsa Republican, said he had “long supported the goals” of the program, but didn’t specify if he would like to see any changes to it.
“I look forward to considering the latest reauthorization this fall in the Senate,” he said in a written statement.
Sen. James Lankford, also a Republican, said he prefers a “clean bill” without major amendments, because it would be more likely to pass.
“I support reauthorization of the children’s health insurance program, as it has helped many families across Oklahoma. It’s unfortunate that Congress has procrastinated and waited until the last minute, yet again, on another important reauthorization or deadline,” he said in a news release.
Rep. Frank Lucas, a Republican from Cheyenne, Rep. Jim Bridenstine, a Tulsa Republican, declined comment. Cole, Rep. Steve Russell, R-Choctaw, and Rep. Markwayne Mullin, R-Westville, didn’t respond to questions about their views on reauthorizing CHIP.
The Children’s Hospital at OU Medical Center released a statement calling on lawmakers to reauthorize the program, which it estimated covers about 122,000 Oklahoma children. Jon Hayes, the hospital’s CEO, said letting the program lapse would be another strain on hospitals, which have had to cope with cuts to Medicaid rates.
“CHIP is a safeguard for our state’s most vulnerable population,” he said in a written statement. “The Children’s Hospital at OU Medical Center, as with all children’s hospitals nationwide, relies on the Children’s Health Insurance Program (CHIP) as an important safety net for patients in need.”