On September 30th of this year, the Children’s Health Insurance Program (CHIP) ran out of federal funding. While CHIP has not received as much publicity as the Affordable Care Act (ACA), it has had a major impact on the American population: providing health insurance for 9 million children who would otherwise not be insured. Despite its success, there is currently a debate about the funding of CHIP.
CHIP, which was passed in 1997 as part of the Balanced Budget Act (BBA 1997), provides block funding for states to implement insurance programs for children that are in families with incomes up to 200 percent of the federal poverty level. Over the past 20 years this program has had a profound impact on children at or near the poverty level: In 1997 it provided insurance for 1 million children; that number increased to 9 million as of 2016. Ten states believe that they will be completely depleted of funding for CHIP by the end of this year and an additional 32 states will be depleted of funding by March 2018.
The Senate Finance Committee and the House Energy and Commerce Committee developed two separate bills that would extend CHIP financing. Both bills proposed to extend CHIP funding until 2022; however, the bills differ in terms of how they address the recently devastated Puerto Rico and how they hope to provide additional funds for the program. The House bill includes 1 billion in Medicaid financing to Puerto Rico. The House bill also allows states to bill third-party insurers and increases Medicare premiums for higher-income beneficiaries, which would help offset some of the costs of CHIP.
It is the exact details and mechanism of the offsets that were causing a delay in the House. The House bill has now been passed and has moved on to the Senate. In 2007, when the initial funding for CHIP was depleted, there was a similar debate about whether or not to continue funding the program. While Congress was able to pass a bill at that time, it was vetoed, twice, by then-President George. W. Bush.
As a medical student studying in Nashville, Tennessee and originally from Ontario, Canada, I have a unique perspective on the American health care situation. Coming from Canada I’m accustomed to everyone having access to quality health care, and because of it everyone having a certain standard of health that they are able to maintain. Moving to America for my undergraduate studies, and subsequently for medical school, I was exposed to a population that is rightly concerned and preoccupied with high health care costs and being able to access health care. The inability for many Americans to access healthcare is disconcerting for me as a health care provider because I see first-hand the inefficiencies of this system that lead to ever-increasing costs. A striking example of this is the use of high-cost emergency room visits which could be offset by strengthened primary and preventative care. An example of this is patient with end-stage renal disease who needs access to anti-hypertensive medications and regular follow-up, but presents to the emergency room with a hypertensive crisis. A scenario like this is rare to non-existent in my home country of Canada.
As a future physician who is interested in health policy, the question of why two large economies should have such different priorities regarding health care remains at the forefront of my mind. What needs to change within the American political and social climates to ensure that these 9 million children do not lose health insurance? While the details of how to fund this bill and how to address offsets are important, the real debate should be about how to more fully incorporate this bill and others like it into the fabric of American culture such that we are not faced with the possibility of vulnerable children losing health insurance.
Nathanael Smith is a medical student.
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