13 Dec

It’s not a real medical insurance problem, it’s just kids

As the new Congress imagines endless imaginative new ways to gut the Affordable Care Act, there’s another major federal health care program that everybody likes, that’s been particularly important to Oregon, and that hangs on a funding stream that runs out next year.

Congress, of course, seems in no hurry to get to it.

Oregon prides itself on its Healthy Kids Act, enacted in 2009, which cut its level of uninsured kids in half completely outside the argument over whether Obamacare was the end of civilization as we know it. But the Healthy Kids Act was mostly just Oregon finally taking up the feds’ offer, in the 1997 Children’s Health Insurance Program, to pay most of the costs for states insuring more low-income children
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Currently, CHIP covers 78,000 Oregon kids, and over the course of a year about 120,000 kids are in the program at some point. CHIP is authorized to run through 2019, but its funding runs out next October and needs to be renewed.

Responding to a letter sent out to governors this fall, Oregon Gov. John Kitzhaber wrote the leaders of the relevant congressional committees, “Oregon has seen a dramatic decline in the numbers of uninsured children by more than 6 percentage points since implementing the State’s Healthy Kids program in 2009 and has a rate of uninsured children 1.5 lower than the national average.” With CHIP kids left to find coverage elsewhere, on parents’ programs or the government exchange, Kitzhaber warned, “as many as half of our CHIP kids may lose coverage, which would erase much of our coverage gains for children over the past five years.”

Moreover, a study appearing Monday in the December issue of “Health Affairs” found that children’s coverage under CHIP is considerably more comprehensive than many of the policies offered under the Affordable Care Act.

Devised by Ted Kennedy and Utah’s Orrin Hatch, CHIP was a bipartisan piece of legislation at a time when such things still existed, and while covering millions of kids has remained widely popular. In a House Health subcommittee hearing on funding last week, nobody – including Republican congressmen – had a bad word to say about CHIP.

But there was no hurry to act, either. Subcommittee chairman Joe Pitts, R-Pa., praised the program and said action would be “thoughtful and data-driven” – congressional code for “We’ll get to it when we get to it.”

By next October, Congress probably will; lots of Republican governors are counting on the money, too. But state legislatures, including Oregon’s, begin writing their budgets next month, and no sane state legislator would base a budget on a congressional promise to be “thoughtful and data-driven.”
Even assuming that the program’s funding is extended, no state can be confident that Congress won’t take another look at benefit levels, such as the pediatric dentistry that CHIP covers and some ACA plans don’t. Currently, Oregon is one of just 18 states that uses CHIP to cover pregnant women; hopefully that option survives.

Sean Kolmar, health policy advisor to Gov. Kitzhaber, noted in an interview Monday that the governor’s budget is based on the current CHIP funding level, and that “The closer we get to a deadline, the more dicey it gets.” The governor’s office, he says, has been in close touch with Oregon’s senators, encouraging action.

For another few days, the Senate Finance Committee, with jurisdiction over CHIP, is chaired by Oregon’s Ron Wyden, who has declared extending funding a priority. But that changes next month, and earlier this fall Bruce Lesley, president of First Focus Campaign for Children, a D.C. advocacy group, worried, “If Senator Wyden is no longer chairing the Finance Committee, I would assume our chances are no longer so good.”

The new chairman will be Orrin Hatch, the program’s original co-sponsor. But that was a long time ago, in a different Congress, and while Hatch has been saying positive things about CHIP, it could face a hard trek through a House cutting to the right like a wide receiver.

It would have benefited a lot of states, not to mention a lot of children, to have gotten the funding issue resolved this year. Now, it passes to next year and the next Congress, which will be finding its way through a thicket of issues and possibly not getting productive until the cherry blossoms bloom in spring.
“I hope they take it up fast,” said Kolmar, “and I hope it’s the bipartisan issue it always has been.”

And hoping that these days, it’s possible for anything to be.

NOTE: This column appeared in The Oregonian, 12/10/14.