Dr. Lanre Falusi knows firsthand the anxiety families face when the future of their child’s health insurance is in jeopardy. A pediatrician at Children’s National Medical Center in Washington, D.C., Dr. Falusi recently had a routine visit from a 7-year-old patient with asthma. For the last few months this little girl has been fairly stable thanks to her daily controller and rescue medication covered through D.C.’s Children’s Health Insurance Program (CHIP). But she often has tough winters and her mother was trying to plan ahead having heard CHIP’s future funding was uncertain.
“That was her question: ‘If I don’t know if she’s going to have insurance, can I get a prescription for extra medication and save it just in case?'” the doctor said. “She was in crisis planning mode for her daughter’s health and she wanted to stockpile the medication. It was really disconcerting to me that that’s what we’re asking parents to start doing. States are dealing with an incredible amount of uncertainty about their funding — and maybe they are used to doing that — but the fact that we’re asking families now to do that around their children’s health is inappropriate and unconscionable to me.”
States and families across the country are in this crisis mode because Congress let the deadline to extend funding for CHIP pass at midnight on Sept. 30 leaving 9 million children like Dr. Falusi’s young patient uncertain about their health coverage. For months Congress has been busy debating whether or not to repeal the Affordable Care Act (ACA) and destroy Medicaid as we know it. While the death of the Graham-Cassidy health repeal bill in late September was a major win for 37 million children who rely on Medicaid for their health coverage, in the midst of that major fight, funding for CHIP was left by the wayside.
Earlier this week it appeared Congress was coming together and might move forward a strong, long-term extension of CHIP with bipartisan support. On Wednesday the Senate Finance Committee quickly passed its Keeping Kids’ Insurance Dependable and Secure (KIDS) Act (S.1827) with the support of all but one member of the Committee, but the momentum for CHIP stalled in the House Energy and Commerce Committee later that evening. While Energy and Commerce approved the HEALTHY KIDS Act (H.R. 3921), a bill with nearly identical CHIP provisions to those in the KIDS Act, it lost the support of all its Committee Democrats because of their serious concerns about bad proposals used to pay for CHIP and other pieces of the bill, especially given that many Republicans don’t seem concerned about how to pay for tax cuts for wealthy individuals and corporations in their “Big Six” tax cut plan. So politics jeopardizes children’s health again.
We’re so close to the finish line. There is bipartisan support for CHIP. Congress is following regular order. If Senate and House members, Republicans and Democrats alike, agree on what we need to do for children’s health, let’s do it now and for the children’s sake forget the need for political wrangling.
Although the deadline has come and gone, most states still have some carryover funds to continue to operate their CHIP programs in the short term, leading many in Congress to erroneously believe the Sept. 30 deadline was arbitrary when in fact it has immediate implications for real children and families. Some states have taken steps to put families on notice and are even prepared to modify or end their CHIP programs because of continuing uncertainty. Every day Congress delays action makes a difference.
“We haven’t fallen off a cliff yet, but the uncertainty that there is a cliff looming ahead makes it harder to help parents think proactively about their child’s health,” Dr. Falusi said. “For me as an individual provider, it can affect the positivity — the certainty of saying, ‘See you back in six months for the two-year well-child visit,’ when I don’t know if they’ll still be insured and able to afford it, or if they’ll be trying to decide between whether they can afford transportation to the pediatrician’s office or transportation to work.”
The Minnesota State Health Department was the first to send a letter to Congress warning that despite predictions that said otherwise, its CHIP funding would run out Sept. 30 and it would have to take “extraordinary measures” to continue coverage in October including the possibility that pregnant women could “be at risk of losing coverage all together.” As a result, earlier this week the Center for Medicaid and CHIP Services took measures to get Minnesota $3.6 million dollars to keep their children and pregnant women covered through October. Nine more states will run out of money before the end of the year and the uncertainty is causing other states to begin contingency planning and start the process of shutting down their programs because Congress has failed to act.
Utah officials have said they will end their CHIP program if Congress doesn’t provide new funding, and officials in a growing number of states have said they may need to follow suit. In her testimony to the Senate Finance Committee in early September, Linda Nablo, Chief Deputy Director of the Virginia Department of Medical Assistance Services and former Virginia CHIP director, emphasized that “there are serious consequences looming if [Congress] delays reauthorization — even for a few months.” While Virginia’s CHIP allotment isn’t estimated to be exhausted until March 2018, issues with health plan payment, adequate notice requirements, eligibility worker training, and system changes will require the state to start taking action in October in anticipation of exhausting their funding.
Parents are getting the message and now that fear is showing up in places like Dr. Falusi’s exam room.
“The urgency is palpable from the family perspective … We know kids have colds, flu and asthma attacks that cluster in the winter. Right now is really the worst time for families to either fear or know for sure their child is about to lose their insurance coverage,” Dr. Falusi said. “Even if there’s a shortfall of a couple of months, in a couple of months a child’s asthma can go from controlled to the intensive care unit, which I’ve seen when kids go off of their medication. … In the life of a child, even a couple of months can have some long-term lasting effects.”
Congress must not leave children, families and their doctors in this dangerous political limbo a minute longer. CHIP has been beloved for 20 years and the CHIP extension has bipartisan support. One-third of children enrolled in CHIP are in the states of House Speaker Paul Ryan, House Minority Leader Nancy Pelosi, Senate Majority Leader Mitch McConnell and Senate Minority Leader Charles Schumer. Children need CHIP now. Why are we letting it get caught up in political posturing and debates? Tell Congress to pass CHIP now and not hold it hostage to partisan disagreements over how to pay for it or any other policy issues. Both the House and Senate will be back at work the week of Oct. 23 and passage of the CHIP extension must be first on their agenda. Please let your members of Congress hear from you why CHIP must be passed now — children need their health care! Congress must stop playing politics with children’s health.
Marian Wright Edelman is president of the Children’s Defense Fund.