The Other Federal Health Insurance Program

Since Republicans took the Senate, much attention has been paid to what happens with the Affordable Care Act. But there is another, lesser-known federal insurance program that Republicans will also have to deal with next year: CHIP.

That acronym stands for the Children’s Health Insurance Program, which gives states federal funding to provide health insurance for children. The program expires next year, and with control of Congress, Republicans are in the potentially awkward position of deciding if they want to renew another government health program or send millions of children onto the Obamacare federal and state exchanges they have long criticized.

Created in 1997, CHIP was designed to cover children in families earning between 200 and 300 percent of the federal poverty level. The aim was to cover kids that fell into the gap between Medicaid and private insurance. Before Obamacare, Medicaid in most states covered families making up to 100 percent of the federal poverty line. In 2013, 8.1 million kids were covered under CHIP, at a cost of $13 billion, an increase of 8 percentage points from the previous year.

The Affordable Care Act significantly changed the insurance market in 2014. With state and federal exchanges, many of the families getting CHIP coverage can now get plans through the exchanges, with the federal government often picking up a sizable chunk of the tab. All of which raises the question of whether the CHIP program is now obsolete.

House Energy and Commerce Subcommittee on Health chairman Joseph Pitts (R-PA) said Congress should extend funding for this program but should be “thoughtful and data-driven in our approach” going forward in a hearing on reauthorizing CHIP last week.

Some Republicans appeared skeptical of the program. Rep. Michael Burgess (R-TX) asked panelists during the hearing last week if there was a need for CHIP anymore now, due to the health reform law’s insurance exchanges.

In the Senate, Republican Orrin Hatch of Utah—who is expected to be chairman of the Senate Finance Committee—was an original sponsor of the legislation behind the CHIP program in 1997. But Hatch voted against the last reauthorization, citing partisan amendments.

In July, Hatch, current Senate Finance Committee chairman Sen. Ron Wyden (D-WA), House Energy and Commerce Chairman Fred Upton (R-MI) and Ranking Member Henry Waxman (D-CA) sent a letter to all 50 governors asking for their input about the CHIP program. More than half of them said CHIP funding should be extending at least through the end of 2019.

Experts at the House hearing agreed, saying CHIP was not redundant and should continue for a few more years.

The Medicaid and CHIP Payment and Access Commission (MACPAC) recommended in a June report that extend CHIP funding for two more years. The commission said more time was needed to examine the affordability and adequacy of children’s coverage in the exchange for CHIP participants who would have to transition into the exchanges.

“Right now the commission’s concern is that the exchanges are not ready for the CHIP kids and that a significant number of kids with CHIP would not be able to afford the exchange coverage,” said Anne Schwartz, executive director for MACPAC, during an Energy and Commerce Subcommittee on Health hearing last week.

Another argument is that exchange plans may not be as comprehensive as CHIP plans, which is often similar to Medicaid plans. National Medicaid Directors Association president Matt Salo said Medicaid represents the “richest benefit package” for children in America.

For example, a May study from the National Academy for State Health Policy (NASHP) and the Georgetown University Health Policy Institute’s Center for Children and Families found only small gaps in coverage between Medicaid and CHIP programs. Fourteen CHIP programs had benefits that were either the same or similar to coverage for children in Medicaid, the report found.

If CHIP ends, HHS is required to certify if the “qualified health plans” offered on the exchanges are comparable to CHIP. But Hess said the agency hasn’t been clear on how they’d approach this.

“When you look at plans on the exchange and private sector they just don’t cover as much as CHIP does,” said Hess.