In the bedlam surrounding massive health care reform it is easy for the proposed impact on less visible and less vocal constituencies to get lost in the escalating shouting match. Case in point: the passage of the mammoth House Health Care Reform bill is dominating television, radio and print news, but nary a mention is being made about children by any of the commentators. It’s a sad statement about the never ending struggle to put children at a higher policy priority in this country.
How did children fare in the health reform package being sent from the United States House to the United States Senate? The answer seems to depend on whom is being asked for their opinion and in which state the child resides.
The most active debate among child health advocates, experts and providers pits the new EXCHANGE mechanism against the historic CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP).
The EXCHANGE would become a new health care insurance delivery system established by law whereby individuals and small firms would shop among a range of health plans for coverage. CHIP is the current state insurance program that covers children who linger at family income levels between those eligible for Medicaid and those who can afford private insurance.
Officials with Congresswoman Kathy Castor’s office (D-Florida 11th) told the Children’s Campaign that Florida will fare better with the health care plan passed last Saturday. They point to many reasons including Florida’s failure to take full advantage of CHIP and the EXCHANGE’S ability to increase the number of children insured at a higher reimbursement rate for the state. Attention was called to the timetable for the switch slated to take place at the beginning of 2013. At any time during the three-year period, CHIP could be reauthorized if it becomes certain that children would be better off with the current program.
Analysts are weighing in also. In an article entitled “CHIP on Chopping Block in House Health Reform Bill” the Washington Independent reports that supporters of the move from CHIP to the Exchange have a variety of reasons; “including hopes to get family members under the same plan”, to centralize control of the state-run CHIP program and to shift more folks into private coverage to win the support of both the insurance lobby and moderate Democrats.”
The House bill calls for a report to Congress from the Secretary of Health and Human Services twelve months prior to the switch on how to ensure that the Exchange coverage is comparable to an average CHIP plan and that appropriate transfer procedures exist.
Opponents to the switch are concerned that the House language lacks the teeth to truly protect children. They point to what they believe will be additional expense to families in trading CHIP for the EXCHANGE.
According to a study commissioned by First Focus, a bi-partisan child advocacy organization, children enrolled in CHIP, depending on income, are only exposed to 0-2% of medical expenses. The EXCHANGE plan passed by the House would expose children to anywhere from 5-35% of costs, greatly increasing the potential financial burden on working families.
Bruce Lesley, President of First Focus states, “CHIP provides comprehensive benefits to children that specifically address their unique health care needs. And it is far more affordable …”
He goes on to make the point that “… for health reform, Congress should be fixing what is broken and building on what works. CHIP works for kids and we should be expanding this program, not phasing it out.”
Bill Bentley, President of Voices for America’s Children, expressed caution about the trade. In a press release responding to the filing of the House health care bill, he posited that “… CHIP be continued until we know whether the exchange can provide benefits and cost sharing protections comparable to CHIP.”
At the root of the advocate’s concern is the untested nature of the Exchange program and the quick movement of children covered under CHIP to Exchange. While not believing that the CHIP program is perfect, some advocates believe it is better for children to have a proven safety net.
In Senate action prior to the vote that took place in the United States House, an amendment by Sen. Rockefeller (D-West Virginia) preserved CHIP during mark-up in the Senate Finance Committee, but failed to provide Early Periodic Screening, Diagnosis, and Treatment (EPSDT) for children covered by CHIP. The amendment will extend CHIP through 2019. The Congressional Budget Office scored the amendment at a $40-billion save, the money was not redirected to children’s services.
Following the addition of the Rockefeller amendment the Director of the Congressional Budget Office stated “under the mark as it was originally offered, which would have eliminated CHIP, CBO anticipated that some of those children would be eligible for subsidized coverage in the exchanges but would not be enrolled in an exchange plan (owing at least in part to the higher premiums and higher out-of-pocket costs that they would typically face in such a plan).”
According to Inside CMS, “The overarching argument is that more kids would have been uninsured if the Finance Committee had transitioned CHIP into the exchange. The Rockefeller amendment, according to the CBO, keeps more kids insured by not putting CHIP kids in the exchange, and Democratic supporters suggested the EPSDT benefit "won't matter if they don't have insurance.”
While the debate about the Exchange and CHIP continues, the House plan moves onto the Senate. First Focus has prepared a side-by-side which compares the House plan which passed and two Senate plans that have moved from committee.
Please send your comments to the Children’s Campaign for future inclusion in our coverage of the health care debate as it relates to children and use these links to be in touch directly with United States Senators Nelson (phone & email) and LeMieux (phone & email).
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