CHIP at a Crossroads

April 26, 2014
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Funding is running out for the Children’s Health Insurance Program, a state-federal partnership that prevents low-income children from falling through the cracks.

Five years since it was reauthorized, the Children’s Health Insurance Program is again facing an uncertain future. Funding for the state-federal partnership will run out next year, putting in jeopardy a program that has resulted in dramatic reductions in uninsured children.

CHIP, as it’s commonly called, covers 8 million children whose families earn too much to qualify for Medicaid but not enough to afford high-quality private health insurance. Since the initial law was approved in 1997, the number of uninsured children in the United States has dropped by 40 percent to a record low of 7.2 million. In 2009, President Barack Obama reauthorized CHIP, expanding eligibility, simplifying enrollment and offering incentives for states to add more children to the program.

But the program could go away if Congress doesn’t act soon. While Obama reauthorized CHIP through 2019, funding will end in October 2015. The Affordable Care Act, approved 13 months after the CHIP reauthorization, provided funding for the program but also cast doubt on its future. Under the ACA, children could be moved from CHIP to the ACA’s health insurance marketplaces. That scenario concerns CHIP supporters. “CHIP is a program that was designed for children,” says Alison Buist, director of child health at the Children’s Defense Fund in Washington, D.C. “It really does have appropriate health benefits and networks for children.”

William Cotton, MD, medical director of the Primary Care Centers at Nationwide Children’s Hospital, says CHIP — though not perfect — is a better option than trying something new. “Pediatricians are pretty scared about that,” Dr. Cotton says. “We think CHIP has been very successful and that the Affordable Care Act won’t cover children as well.”

With states already planning for next year, Congress will need to act in the coming months to make sure children in the CHIP program don’t lose their coverage. The idea, however, could face opposition. Though originally bipartisan, CHIP has become more controversial in recent years. President George W. Bush twice vetoed CHIP reauthorization legislation. Plus, the political fallout from the ACA makes any kind of health care proposal more controversial these days. “We have our work cut out for us,” says Dr. Buist.