The Washington Post

Trump is not the first to tar­get CHIP

- Sign up for The Health 202 at wapo.st/geth­ealth202. PAIGE WIN­FIELD CUN­NING­HAM

Pres­i­dent Trump on Tues­day pro­posed a hefty 20 per­cent cut over the next two fis­cal years to the Chil­dren’s Health In­surance Pro­gram (CHIP) in his bud­get. Democrats will protest, but they, too, toyed with the idea of elim­i­nat­ing CHIP seven years ago when pass­ing the Af­ford­able Care Act.

In a per­fect world, the ACA would have on its own ex­tended cov­er­age to all chil­dren in the United States, as their par­ents got cov­ered through Med­i­caid ex­pan­sion and fed­er­ally sub­si­dized plans. Un­der ideal con­di­tions, the 2010 health-care law was sup­posed to fill in all of the coun­try’s health-cov­er­age holes and put an af­ford­able plan within reach of ev­ery Amer­i­can.

It was with this best-case sce­nario in mind that some House Democrats pro­posed their health-care law elim­i­nat­ing CHIP, think­ing that the law’s new mar­ket­places could pro­vide bet­ter cov­er­age for chil­dren from low-in­come fam­i­lies. Some felt that CHIP might be du­plica­tive un­der the ACA’s cov­er­age scheme.

“Oba­macare raises the ques­tion of why [CHIP],” said Rodney Whit­lock, a former health-care staffer for Sen. Charles E. Grass­ley (R-Iowa) and vice pres­i­dent at ML Strate­gies.

In­deed, an early House ver­sion of the ACA would have phased out the pro­gram at the end of 2013, mov­ing some chil­dren into mar­ket­place plans and oth­ers into Med­i­caid. But sen­a­tors who helped orig­i­nally pass CHIP in 1997 – most notably Sen. John D. Rock­e­feller IV (D-W.Va.) — pushed back, ul­ti­mately suc­ceed­ing in re­tain­ing the pro­gram in the fi­nal health-care law.

Fast-for­ward to now. Low- in­come chil­dren get health in­surance from a com­pli­cated and over­lap­ping web of pro­grams, in­clud­ing CHIP, Med­i­caid and Oba­macare mar­ket­place plans. Each pro­gram has dif­fer­ent cost shar­ing and pre­mium re­quire­ments, doc­tor net­works and eli­gi­bil­ity stan­dards, which can lead to dis­par­i­ties in cov­er­age.

Yet here’s another re­al­ity. It turns out that Oba­macare didn’t achieve the cov­er­age gains ev­ery­one had hoped for. About two-fifths of states didn’t ex­pand their Med­i­caid pro­grams. Mar­ket­place en­roll­ment has fallen short of pro­jec­tions. About 28 mil­lion Amer­i­cans re­main un­cov­ered.

So while CHIP does over­lap with parts of Oba­macare, it has con­tin­ued to play a vi­tal role in get­ting chil­dren cov­ered. Thanks to that pro­gram, work­ing in con­cert with the ACA, the num­ber of unin­sured kids has been cut al­most in half since 2008. Ninety-five per­cent of chil­dren in the United States now have cov­er­age. About 9 mil­lion kids have cov­er­age through CHIP.

This is a suc­cess both par­ties can cel­e­brate. Democrats and Repub­li­cans ar­gue over whether adults should be re­quired to pur­chase health cov­er­age, but there’s near-unan­i­mous con­sen­sus that chil­dren should be in­sured. Sen. Or­rin G. Hatch (Utah), the top Repub­li­can on the Se­nate Fi­nance Com­mit­tee, teamed up with Rock­e­feller to pass CHIP ini­tially and has been a top pro­po­nent for it ever since.

Yet Trump took aim at CHIP in the more de­tailed bud­get the White House re­leased Tues­day. The bud­get rep­re­sents lit­tle more than a wish list for the pres­i­dent. But his pro­posal is notable for two rea­sons.

First, Trump’s bud­get as­sumes Oba­macare re­peal, in which case CHIP would be­come even more im­por­tant for en­sur­ing that chil­dren have health cov­er­age. Sec­ond, it’s a health-in­surance pro­gram with wide bi­par­ti­san sup­port. There’s been some drama ev­ery now and then when Congress had to reau­tho­rize it — such as when Pres­i­dent Ge­orge W. Bush ve­toed a bill dra­mat­i­cally ex­pand­ing it — but law­mak­ers have been will­ing over­all to keep it go­ing.

There is a “bi­par­ti­san de­sire within the Fi­nance Com­mit­tee to en­sure fund­ing for CHIP is con­tin­ued and ser­vices for vul­ner­a­ble chil­dren is main­tained,” said Hatch spokes­woman Ju­lia Lawless. “Chair­man Hatch will con­tinue to work with mem­bers and the ad­min­is­tra­tion to find a vi­able path for­ward.”

Trump sug­gest­ing CHIP cuts also il­lus­trates a closely held fear of lib­er­als that GOP-backed changes to Med­i­caid would make it much eas­ier for Congress to cut that pro­gram in the fu­ture.

CHIP is a block-grant pro­gram, mean­ing the fed­eral gov­ern­ment con­trib­utes a set amount in­stead of pay­ing a spe­cific per­cent­age of states’ costs. Many Repub­li­cans want to con­vert Med­i­caid to a sim­i­lar pro­gram in or­der to limit fed­eral spend­ing.

But bas­ing Med­i­caid on block grants could make it a lot eas­ier for Congress to dial back spend­ing on the pro­gram in the fu­ture when it’s look­ing for ways to fund other pri­or­i­ties.

“If you cap Med­i­caid, it turns into a piggy bank and this CHIP pro­posal re­ally re­in­forces that,” said Joan Alker of the Ge­orge­town Cen­ter for Chil­dren and Fam­i­lies.

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