CHIP Program Enters Into Crossroads
by Dennis Cooley, MD, FAAP
KAAP Past President
The Child Health Insurance Program (CHIP) has been one of the successes in providing health care to children in the United States. Since its inception, CHIP has decreased uninsured children in the United States by 50%.
In our state, CHIP is a separate program from Medicaid but has been marketed under the same name since 2001. The current name for the program is KanCare. CHIP will cover what Medicaid doesn’t in a stair step manner depending on the age of the child (up to a maximum of 225% of the 2013 FPL). In 2012 the average monthly CHIP enrollment in Kansas was 49,000. Overall in the State’s Medicaid/CHIP program, CHIP enrollees make up 12%.
When the CHIP program was initially passed it received strong bi-partisan support. It has been reauthorized once. Unfortunately, CHIP is now being looked at in light of the ACA. When the ACA was passed, CHIP was “reauthorized” until 2019; but funding for the program was only provided until 2015. The result is that if the program is to prevail it must get Congress to pass legislation for continued funding. Because of the uncertainty of the ACA and the fact that funding wasn’t guaranteed by the legislation, there is concern in some quarters that this vital program may fall to the wayside.
Why would CHIP not be funded? Here are some of the reasons that we have heard. There are some individuals who believe the government should not have any role in health care – this should be left to private industry. Others believes CHIP enrollees can be switched to the health exchanges and so the program is not needed. Along those same lines, some argue that all family members should be in the same insurance programs and thus CHIP enrollees should be moved to exchanges. Finally there are those that feel the program (along with all other safety net programs) costs too much.
As to the first argument (whether you like it or not), the government is going to be involved in providing health care. The CHIP program has been an example of how successful a government program can be. It has been in existence since before the ACA and is separate from the controversial law. It has received bi-partisan support.
Exchanges are not a good substitute, either. First off, benefit packages in the exchanges are not the same as those provided for in the CHIP program. Also, some of the provider panels in the exchanges are smaller. Some children may not actually qualify for the exchanges despite being eligible for CHIP. At the recent COFGA meeting, we were presented data that 21% of CHIP enrollees would be ineligible for the exchange. Finally, the cost sharing is significantly higher in the exchanges.
We have some time to save this program, but as we have seen, Congress can wait until the last minute to make decisions. We feel it is vitally important that pediatricians start now with contacting their congressional representatives and encourage them to refund CHIP.