CHIP on the block: Should the Children’s Health Insurance Program continue?

chopping block CHIP
Some believe that ACA's insurance exchanges leave gaps in pediatric protection.
Funding for the federal Children’s Health Insurance Program (CHIP) will run out in 2015. Will this leave many kids without health insurance?

About 8 million children currently receive health insurance through CHIP, created in 1997 to bring coverage to children whose families earn too much to qualify for Medicaid but not enough to buy private insurance. States administer the program and receive federal matching funds to cover costs. In 2009, Congress reauthorized funding for CHIP through 2015.

What will happen to CHIP beyond 2015 is uncertain, not just because of the funding deadline but also because of changes brought on by the 2010 Affordable Care Act (ACA). Many believe that the ACA’s Medicaid enrollment incentives and expanded tax credits will add so many lower-income kids to the insurance rolls that CHIP will become unnecessary and simply go away. Others, however, say that the plans sold through the ACA’s insurance exchanges could produce gaps in coverage for children, making it crucial to keep CHIP funded.

Joshua Greenberg, JD, vice president of government relations at Boston Children’s Hospital, believes that “we should preserve CHIP, because it has made a sincere attempt to offer benefits and services that are tailored to the needs of children.”

The bill to reauthorize CHIP in 2009, for example, contained $225 million in funding for quality improvements and information technology.  The reauthorization also called for enhanced reporting of pediatric services and outcomes, established state demonstration projects to test new approaches and funded seven national centers of excellence to develop new quality measures.

Greenberg also believes that CHIP may need to continue, because some of the plans sold through the ACA’s health insurance exchanges present problems for kids. “Many of the ACA plans do not have strong pediatric protections,” he says, “and some children’s hospitals are being excluded from the new provider networks offered by exchange plans.”

The Medicaid and CHIP Payment and Access Commission (MACPAC), which advises Congress on Medicaid and CHIP, also sees problems with ACA health plans. The organization contends that ACA provisions enable 44 percent of current CHIP enrollees to receive subsidized coverage, but the rest are ineligible for care because their parents can receive employer-based insurance. What’s more, MACPAC reports, many ACA health exchange plans have higher premiums, co-payments and deductibles than CHIP plans. These costs could “price out” some low-income families.

Although much can happen between now and 2015, Greenberg believes that CHIP will be extended. “CHIP was a bipartisan program in its origins,” he points out. This could help reauthorization efforts. In addition, he notes that “CHIP has been a good focal area for political activity to improve children’s health more generally.”

“We’ve tied a lot of important things to it, like investments in quality improvement,” Greenberg states. “Until we see a credible alternative that similarly focuses on child health needs, children will be better served by preserving CHIP.”