Dr. Brian Johnston has been a pediatrician at a clinic at Harborview Medical Center for 20 years, and practiced in the field for 10 before that. He’s passionate about children’s health care, and in December he was pretty upset that Congress had, as of yet, refused to act to protect CHIP, the Children’s Health Insurance Program.
“The delay on CHIP funding is frustrating to me,” Johnston said. “It was bipartisan when it was created. Only this year in a highly polarized climate in D.C. they allowed funding to expire and distracted themselves with giving tax cuts to billionaires.”
A week later, Democrats joined Republicans to approve a temporary spending measure, punting fights over health care and the fate of 800,000 undocumented immigrant youth into January, prolonging the misery of uncertainty for millions of people while taking time off to spend the holidays with their families.
Although CHIP isn’t dead yet, its survival is not certain. If it’s not renewed in an ongoing fashion as it has been for the past 20 years, the state of Washington could face a difficult choice: risk health insurance for tens of thousands of kids or find roughly $176 million in its couch cushions to cover the costs.
Congress passed CHIP funding for the first time in 1997. The idea was simple: Give states money to insure kids whose families make too much money to qualify for Medicaid, the health insurance program for low-income adults and families, but too little to buy insurance themselves.
Although the original legislation was advanced by Sen. Orrin Hatch (R-Utah) and Sen. Ted Kennedy (D-Massachusetts), then-First Lady Hillary Clinton is given and has taken much credit for pushing it through to the president’s signing desk and its successful rollout to families across America.
Washington decided to tap that funding stream in 1999, using it to cover children and families who made between 200 and 250 percent of the federal poverty level. But in 2003 advocates decided to start pushing for more, said Jon Gould, executive director of the Children’s Alliance, a nonprofit group that fights for the rights and well-being of children.
Health care access is important for moral reasons, but also for practical ones.
The effort culminated in 2007 with the passage of the Cover All Kids Act, a law that expanded Apple Health For Kids to children whose families make up to 312 percent of the federal poverty level, regardless of immigration status.
A decade after the passage of that law, 97.5 percent of children in the state of Washington have health coverage. Apple Health for Kids covers half of them.
Health care access is important for moral reasons, but also for practical ones, Johnston said.
Children with health insurance have easier access to vaccines — the more people in a population who are vaccinated against diseases like polio, the safer everyone is from a recurrence of those nearly-eradicated illnesses.
They also get preventative care, which means catching problems early before they snowball into larger threats and more costly emergency room visits.
It also strengthens the economy. Parents go to work instead of staying at home with sick children. Medical expenses remain a leading cause of bankruptcy; that can be avoided, as well as the homelessness that can follow when a family finds itself unable to make rent or mortgage payments. Children miss less school, which impacts future employment.
“I think that’s part of the argument in the cost-effectiveness of pediatric care,” Johnston said. “I don’t think there’s a lot of debate about this.”
That success is in jeopardy if Congress doesn’t reauthorize CHIP.
It’s not like they haven’t tried. Hatch joined with Sen. Ron Wyden (D-Oregon) to pass a “clean” CHIP bill through the Senate Finance Committee, meaning the legislation would reauthorize the funding without strings attached.
The Republican majority of the House of Representatives, however, did not.
Instead, the House offered a CHIP bill that would have paid for the program by cutting other health care provisions, such as making it more difficult for people who buy insurance on public exchanges to maintain health coverage and slashing the Prevention and Public Health Fund, which in part funds research at the Centers for Disease Control and Prevention.
Democrats rejected the deal, and political observers called for the minority party to use what leverage it had to force Republicans to pass a clean CHIP extension for five years, the normal reauthorization period, or withhold their votes to fund the government.
That didn’t happen.
Now, the party that pushed through a $1.5 trillion tax cut — which overwhelmingly benefits the super wealthy and threatens to force across-the-board cuts to social safety net programs such as food stamps — says that it simply may not have the money to pay for health care for kids.
“Nobody believes more in the CHIP program than I,” Hatch said on the Senate floor. “I invented it. We’re gonna do CHIP. There’s no question about it in my mind, and it’s gotta be done the right way. The reason chip’s having trouble is we don’t have any money anymore.”
If the federal government won’t fund CHIP, Washington will have to, Gould said.
Gould watched as other states languished without funding in the months after lawmakers failed to reauthorize CHIP by Sept. 30. Some, like Colorado, sent out notices to families telling them that their children would lose access to health care.
Not here, he said.
“Fluctuations in federal funding happen all the time. They’re not unusual,” Gould said. “This is an unprecedented situation in that we don’t know when Congress will act — if Congress will act — and this may last a couple years.
“But we’re going to do everything that we can to advocate with families and convince the Washington Legislature that health coverage for children is a bedrock and shouldn’t go away because the federal government doesn’t prioritize it anymore,” Gould said.
Gould quoted $176 million that flows to Washington from the federal government because of the CHIP program, and his coalition wants that to come from the general fund rather than any special funding mechanism.
That’s a lot of money for a legislature that is struggling to craft a budget that can fully fund education, among other services.
He’s confident that can happen.
“This is not the first time that Apple Health for Kids has been tested,” Gould said.
He doesn’t believe it will be the last.
Ashley Archibald is a Staff Reporter covering local government, policy and equity. Have a story idea? She can be can reached at ashleya (at) realchangenews (dot) org. Twitter @AshleyA_RC
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