Yesterday, Congress passed a stopgap-funding measure ending a three-day government shutdown. While competing theories and opinions swirl around the media and Twittersphere about political winners and losers, the facts are clear: some kids and their families came out winners while some young people and families remain in the crosshairs. Funding for the Children’s Health Insurance Program (CHIP) for an additional six years at no cost to the federal government is a relief for families, but overall, the spending measure leaves too many behind. Pitting Dreamers and their families against CHIP funding was always a false choice because Congress could have addressed both priorities simultaneously.
What is in the continuing resolution?
The legislative package itself is not new. The continuing resolution (CR) includes the same bipartisan CHIP policy agreement that surfaced in October with an additional year of federal funding for the program (again, at no cost to the federal government).
Community health centers and other important health programs, such as Medicaid funds for Puerto Rico remain unfunded and in turmoil. The ongoing uncertainty is very difficult for state budgeting and the 25 million families who rely on these centers for health services. CHCs sit at the center of our health system, providing core services and supports, particularly to communities of color.
The CR also delays key ACA tax provisions, including the medical device tax and the tax on high-cost employer plans (Cadillac tax).
Finally, Senators McConnell and Schumer reached a “gentlemen’s agreement” to bring a vote on immigration to the Senate floor by February 8.
How is CHIP affected?
The Children’s Health Insurance Program can now rely on six years of funding with some changes to the financing formula. The continuing resolution includes a wind down of the 23-percentage point enhanced CHIP payment by 2021. There will be a tapering down of the enhanced match over two years starting in 2020 with a reduction to 11.5 then returns to the regular CHIP enhanced matched rate in 2021. This provides states some lead-time to adjust their budgeting to accommodate the funding loss. CHIP will continue to have a maintenance of effort (MOE) requirement through 2019 per the ACA but now extends this provision to children whose family’s income is under 300 percent of the federal poverty level until 2023. The CR also extends Express Lane Eligibility (ELE) and funding for the obesity demonstration project, the pediatric quality measurement program and outreach and enrollment grants—all until 2023.
What did Congress leave on the table?
In short, Congress left federal savings on the table. When Republicans pushed through their tax bill, they stripped the individual mandate from the ACA. The change in the mandate policy altered the Congressional Budget Office’s (CBO) estimate of the cost of the Children’s Health Insurance Program (CHIP). You can dig more into why the mandate relates to the cost of CHIP here. The new CBO score, over a ten-year window, estimated that CHIP would cost the federal government nothing by six years and thereafter, saves the government money. Congress had the opportunity to extend CHIP for a minimum of ten years and save the federal government money. They opted not to pursue this policy option. Just to be clear: Congress bypassed the option to fund CHIP for 10 years at a minimum and save the federal government money.
The work ahead
Many states will take a half-breath of relief as they can now plan budgets with the security of federal CHIP funding. That said, the wind down of the enhanced match places some state CHIP programs in jeopardy. Most notably, Arizona faces a freeze or termination of its KidsCare program if its state legislature does not act to remove a sunset trigger if the 23-percentage point enhanced match ends. Other states face similar predicaments. Robust advocacy in these states is underway and needs our support.
At the federal level, children and families continue to need our advocacy—and we will not rest until all families have access to the health care they need to be healthy. We will continue to provide support to our immigration partners as they work for a Dreamer solution. We will continue to fight for funding and sustainability for community health centers and key programs that provide vital health services and supports to our communities. We will continue to demand that health care remains central to debates about the future of this country as so many families go without needed health services. We are not done—we are just getting started.