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OPINION
Continued from page 19
UNINSURED CHILDREN
Now, working as a community pediatrician on San Antonio’s
South Side, I have a much better understanding of the critical im-
portance of CHIP for low-income children. Currently, CHIP pro-
vides coverage to more than 8 million children nationwide,
including more than 500,000 children in Texas and 35,000 chil-
dren in Bexar County. Created in 1997, CHIP was designed to ex-
tend health insurance to a targeted group of low-income children
who did not qualify for Medicaid. This group included children
living in families with incomes between 100 percent and 200 per-
cent of the federal poverty level. Since then, the percentage of unin-
sured children in that income range has dropped from nearly 23
percent in 1997 to roughly 10 percent today. Likewise, the per-
centage of uninsured children across all income levels also has
dropped to historic lows (although Texas continues to rank among
the worst three states). In short, CHIP has been a rousing success.
While CHIP tends to be equated with Medicaid during policy
discussions, it is important to delineate its unique aspects. One of
the most salient differences is that CHIP includes cost-sharing in
the forms of insurance premiums and co-payments. Such cost-shar-
ing is affordable for low-income families when compared to the
high deductibles of many private insurance products. CHIP also
is unique because it is not a mandatory program for states. Despite
this, every U.S. state, territory and the District of Columbia have
developed CHIP programs. Another reason that contributes to its
popularity is that the match rate for federal dollars is approximately insuring the employee only (not accounting for the cost of covering
20 percent to 30 percent higher than that for Medicaid. States also
have the ability to further customize CHIP programs in terms of
covered benefits, eligibility limits and program design. Finally,
CHIP is highly regarded as a successful public insurance program
which has enjoyed bipartisan support since its inception.
The initial legislation for CHIP was co-authored by an unlikely
couple: the “Lion of the Senate,” the late U.S. Sen. Ted Kennedy
(D-Mass.), and soft-spoken conservative Sen. Orrin Hatch (R-
Utah). To comply with the existing balanced budget agreement,
the program was funded by an increase in the federal cigarette tax.
It was first passed by the Republican-controlled Congress and
signed into law by President Bill Clinton. However, despite its bi-
partisan origins, its history hasn’t been without controversy. Per-
haps most notable were two prior presidential vetoes of CHIP
reauthorization during the second term of President George W.
20 San Antonio Medicine • March 2015
Bush. Thankfully, CHIP was eventually extended by passage of the
Children Health Insurance Program Reauthorization Act
(CHIPRA), one of the first bills signed by President Barack Obama
in early 2009. CHIPRA both reauthorized and funded the pro-
gram through 2013. With the passage of the Affordable Care Act
(ACA), funding was continued until Sept. 30, 2015. Complicating
matters was how the ACA simultaneously called for states to con-
tinue offering CHIP coverage at current eligibility levels through
2019 (without allocating additional dollars). This has left state
health officials with quite a sense of unease.
If Congress does not act, it is estimated that most states will run
out of federal CHIP dollars in the first two quarters of FY 2016.
Congressional inaction would leave millions of low-income chil-
dren without viable insurance options while creating uncertainty
for state legislatures attempting to plan budgets. As CHIP is re-
examined, some have argued that funding should be decreased. In
theory, low-income children should have access to affordable cov-
erage options through the exchanges and associated tax credits.
Unfortunately, “theory” has not necessarily translated into health
insurance reality for these kids.
‘FAMILY GLITCH’
Numerous states have been stubborn in implementing the ACA.
The “family glitch” describes faulty math related to how the IRS
identifies qualified health plans as affordable based on the cost of
dependents such as children). As such, pediatricians and child ad-
vocates everywhere are concerned that children currently covered
by CHIP would be “lost in transition” if the program is diminished
in size or significantly altered. It is for this reason that the American
Academy of Pediatrics is calling for a four-year extension of CHIP
during which the program can be more thoroughly studied in the
ever-changing health insurance marketplace.
Federal legislators recognize the need to consider the future of
CHIP. During the final months of the 113th Congress, both House
and Senate versions of the “CHIP Extension and Improvement Act
of 2014” were introduced and subsequently discussed at two separate
congressional hearings. Democratic and Republican elected officials
alike pledged their support for CHIP and celebrated its history as ev-
idenced by glowing rhetoric. Unfortunately, such rosy commentary
did not translate into legislative progress for kids.