Future of children’s healthcare program already under debate

Though years away, the expiration of the popular Children’s
Health Insurance Program (CHIP) is already getting some attention on Capitol
Hill.

It was just one line at the end of a long speech praising CHIP. But Sen. Max Baucus’s (D-Mont.)
comment this month that the popular initiative might assume “a
different role” as healthcare reform evolves has raised the eyebrows of
some children’s welfare advocates, who fear that shifting kids to private exchange
plans will hike costs and erode services.

{mosads}”If the exchange is as good as CHIP, then
fine,” said Bruce Lesley, president of First Focus, a children’s welfare
group. “But these plans are not going to be as strong as CHIP — there’s no
way.”

In Baucus’s comments, Lesley said, “I see flashing
danger lights.”

Sen. Bob Casey Jr. (D-Pa.) this week also warned of the
potential dangers of eliminating CHIP.

“Children are not little adults,” Casey said
Friday in an e-mail. “They have their own unique health and healthcare
needs. We bring children to see pediatricians because they are doctors that
have the knowledge and expertise to treat children specifically; likewise, CHIP
is a program built specifically for children.”

It’s not the first time the issue has surfaced. During the
months-long debate over healthcare reform, Baucus, who chairs the Finance
Committee, had initially proposed to eliminate CHIP, shifting those kids
instead to either Medicaid or private plans on state-based exchanges. (CHIP,
under Baucus’s plan, would have remained as a secondary insurance option to
cover services that exchange plans didn’t.)

Meanwhile, House Democrats proposed to repeal CHIP
altogether.

The Congressional Budget Office (CBO), at the time,
estimated that the Senate proposal would push greater costs on affected
families, leading some kids to lose coverage altogether.

“Some of those children,” wrote CBO Director
Douglas Elmendorf, “would be eligible for subsidized coverage in the
exchanges but would not be enrolled in an exchange plan (owing at least in part
to the higher premiums and higher out-of-pocket costs).”

The warning hasn’t been tested. Instead, Sen. Jay
Rockefeller (D-W.Va.) amended the Finance bill to extend CHIP’s funding by two
years, through 2015 — a provision that ultimately became law.

The timeline is already on Baucus’s radar.

“In 2015, Congress will revisit CHIP in a new
context,” Baucus said last week during a speech marking the program’s 13th
anniversary. “CHIP has been instrumental in providing children with access
to care where none existed before, but it may need to take on a different role
as health reform is implemented.”

A Finance aide said Friday that the remarks were not a
reference to any specific proposal. Rather, “Baucus wants to ensure that
as the new healthcare law is implemented, the CHIP program has the flexibility
it needs to do whatever is best for the kids and families that rely on the
program,” the aide said in an e-mail.

“[H]e is keeping all options on the table for CHIP’s
future.”

Some kids’ healthcare advocates support that plan. Tricia
Brooks, health policy expert at Georgetown University’s Center for Children and
Families, said Friday that the program providing the coverage — be it Medicaid,
CHIP or the exchange — is no matter as long as kids are getting the care they
need.

“There are many paths to coverage,” Brooks said
Friday. “The important thing is that they serve kids well.”

But Lesley argues that the costs and benefits of exchange
plans under the reform law are already well-known — and they don’t measure up
to the benefits of CHIP plans.

“I don’t necessarily know what people are waiting to
see,” Lesley said.

All sides of the debate agree that the 13-year-old CHIP
program — which covers kids too wealthy to qualify for Medicaid, but not
wealthy enough to afford their own health insurance — has been a boon for kids’
health coverage, particularly in the recession.

Indeed, between December 2007, when the recession officially
started, and December 2008, the number of uninsured adults rose by 1.5 million,
while the number of uninsured kids fell by 800,000, according to the Kaiser
Family Foundation. The difference is attributed largely to state efforts to
maintain, and even expand, their CHIP programs, which currently cover more than
9 million kids and pregnant women.

“CHIP isn’t just a program that was built for children
— it is a program that is working for children,” Casey said Friday. The
Pennsylvania Democrat had pushed a provision, passed in the health law,
requiring the White House to certify which exchange plans offer pediatric
coverage comparable to CHIP.

Still, supporters of repealing CHIP — a group that includes
a number of liberal Democrats who once championed the program — argue the
advantages of having parents and kids all covered under the same plan. They
also note the inconvenience — not to mention the uncertainty — of having to
renew the program every few years. Additionally, they hope to centralize control
of CHIP, which is a block-grant program managed by state officials with powers
to scale back coverage when budgets get tight.

“Families in the exchange or Medicaid will not have the
same problems,” Rep. John Dingell (D-Mich.) said during the healthcare debate
last year.

Other Democrats aren’t so sure. Rockefeller, for instance,
has made clear what he thinks about moving youngsters from CHIP to the
exchange, “where they’re at the mercy,” he said last year, “of
people who will have them for lunch.”

He was talking about private insurance companies.

“I don’t think there’s any reason,” Rockefeller
said, “to dismantle a program that works.”