Tag Archives: CHIP Reauthorization

After Months In Limbo For Children’s Health Insurance, Huge Relief Over Deal

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https://www.npr.org/sections/health-shots/2018/01/23/580062690/after-months-in-limbo-for-childrens-health-insurance-huge-relief-over-deal?utm_campaign=KHN:%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=60184347&_hsenc=p2ANqtz–pQlDPcJILKr6yp-eSvZFNnb5kBt7mE8ZMX0o6x19FCrM34maHyPdMJLgF5dUWUMK9ub4UDcZis67bQkFv3w-i_lnhbQ&_hsmi=60184347

When parts of the federal government ground to halt this past weekend, Linda Nablo, who oversees the Children’s Health Insurance Program in Virginia, had two letters drafted and ready to go out to the families of 68,000 children insured through the program, depending on what happened.

One said the federal government had failed to extend CHIP after funding expired in September and the stopgap funding had run out. The program would be shutting down and families would lose their insurance.

The other letter said they didn’t need to worry anymore because federal funding had finally come through and the program’s future was assured.

Since Monday’s deal to end the shutdown included a six-year reauthorization of CHIP, enrolled families in Virginia will get that second letter. The program will go on and no children will lose their health insurance.

Taking Stock Of Costs

After months of uncertainty, Nablo said she’s relieved. “Hugely relieved. It’s over and the program is safe, and we can all go back to our normal jobs,” she laughed.

Preparations to shut down the program in Virginia down began over the summer, even before funding expired. Staff spent untold hours getting ready to end the program, retooling enrollment systems, changing contracts and more.

“Those aren’t huge dollar amounts,” Nablo said. “I think the cost more is in the worry from parents.”

CHIP covers children in low-income families — most can’t afford private insurance and their children might have had to go uninsured. Nationally, about 9 million children get health coverage through CHIP.

An Unprecedented Situation

In its 20-year history, CHIP had always been uncontroversial, even popular in both parties. Its funding needs to be periodically renewed, and it always had been taken care of well in advance of the money running out.

CHIP is a match program — states and the federal government split the cost. When states made their budgets for this year, they assumed federal funding for CHIP would be there, so they were blindsided by the funding gap.

Every state’s calculus for how long they could run on leftover money was different. In Texas, Hurricane Harvey threw off that state’s projections. Because of the disaster, it waived fees for CHIP and enrollment spiked, so it had less money coming in and more going out.

A handful of states — including Virginia — sent out letters warning families their coverage was in jeopardy because of the uncertainty in Congress.

“One state — Connecticut — did freeze enrollment between the week of Christmas and New Year’s,” said Joan Alker of the Georgetown University Center For Children and Families, which monitored CHIP funding closelyduring the last few months.

Virginia’s Nablo said there might be other, more subtle, costs from all the uncertainty.

“I can’t quantify it, but I am sure there are states that held off on things like mounting an outreach program to encourage people to enroll because they didn’t know if the program was going to be there for them,” she said. “There may have been states that were thinking of implementing some efficiencies or innovations, but didn’t because — again — is the program going to be there?”

Six Years Of Certainty

Alker is happy with the CHIP deal Congress passed. She does point out it’s the same one they agreed on in September, so she’s not sure why it took a shutdown to finally get it through.

The deal keeps the federal investment in the program at its current level for two fiscal years. After that, the amount that states have to pay for the program will increase.

“At least states now have time to plan for that,” Alker said. “Overall, it really was a fair and reasonable compromise.”

She is puzzled, though, as to why it was only a six-year extension when the Congressional Budget Office estimated extending CHIP for 10 years would save the federal government $6 billion.

“The six-year [extension] is a small saver — it saves just under a billion dollars,” Alker said. “Now there’s nothing preventing Congress from coming back as they move ahead with the bigger budget deal — they could come back and extend CHIP for four more years and grab those savings.”

Impact On Children’s Uninsured Rate

Alker does worry that the months of uncertainty around CHIP may have already caused children to drop out of the program, increasing the uninsured rate among children. That should become clear in the fall, when the Georgetown Center For Children and Families does its annual assessment of the children’s uninsured rate.

If that trend develops nationally, it hasn’t been the case in Virginia, where CHIP enrollment went up this past fall.

“We actually saw a boost in enrollment,” Nablo said. “I can’t really quite explain it.”

Maybe, she said, it was all the attention the unprecedented funding crisis brought to CHIP. A silver lining, perhaps, to many months of anxiety.

 

Don’t read too much into health care’s high poll rankings

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https://www.axios.com/dont-read-too-much-into-health-cares-high-poll-rankings-2521856369.html

Image result for ap/norc poll healthcare

An AP/NORC poll published late in December found that health care ranked number one on the list of the public’s priorities for government. It’s a well done and well reported poll, and as the head of a health policy and journalism organization, I suppose I should be happy that health ranked number one.

Yes, but: Having conducted and watched health care polling for decades, I’d caution readers not to over-interpret health care’s first place finish, which may not mean very much for upcoming elections. They are unlikely to be about health care and are much more likely to be about the candidates and President Trump.

Between the lines: For one thing, health care has been in the news and hotly debated. So when given a list of issues to choose from on a poll, or asked to name issues on their mind in an open ended question, the public is more likely to pick health care.

The economy is doing well, and health care’s other major competitor on a polling list of issues, the tax legislation, has not grabbed the public yet and may not until people begin paying their taxes.

The catch: When a topic like health care ranks high on a list of issues, it doesn’t mean voters will vote on that issue. In many races, they are more likely to vote on the basis of how they feel about the candidate overall than on issues. These upcoming elections are also likely to become a referendum on President Trump, as the race in Virginia largely was.

We also cannot assume that when the public picks “health” or “health care” on a poll they always mean the Affordable Care Act, whether that’s repealing it for Republicans or protecting it for Democrats.

  • People will give you a typically partisan view of the ACA if you ask for it. But most Americans are not covered by the ACA, and our own polling at the Kaiser Family Foundation shows that the public is mostly concerned their own health care costs.
  • Other health concerns also creep into the mix on various polls, such as CHIP funding and opioids.

What to watch: In the AP/NORC poll, Republicans placed a lower priority on health than Democrats and Independents did; they were about equally likely to pick immigration and taxes as health care. But we know from other polling that Democratic intensity about the ACA has increased, while Republican intensity is flat.

For that reason, Democrats are likely to put forward a variety of health care plans in 2018 and 2020, which will keep health care on the agenda. Health care could be for Democrats what it has been for Republicans in recent elections — a jump starter for the base. This could be the main way in which it plays a role in the election.

The bottom line: It’s always good to remember that the top issues in polls are not often the top factors in elections, especially in a year when, one way or another, Donald Trump will be on every ballot.

https://www.apnews.com/d0d4166afad649ac994e60f8d0b0da48

 

From premiums to politics: 5 predictions for the health insurance industry in 2018

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https://www.fiercehealthcare.com/payer/year-preview-predictions-politics-aca-mergers?mkt_tok=eyJpIjoiTnpreE9HSTFPVFJqWldZMSIsInQiOiJNM0NTa1ZBZW1kU001bkx4SEcwNmtSeEFVNG9oZnpUbEF2UVpMY1lDUWNZYm8zZTFuejJNUGpPOTJuYVlXTlZwWHdXU1hrRm50Z1NFbHJGRjdUMld6U1JoYWo0enNaUlEzNldab2tcL3hxV3NPaTBlK2xKbmVSQmgwMTE2NFZpYzgifQ%3D%3D&mrkid=959610

Businessman uses a crystal ball

After the demise of two major insurer mergers and multiple Affordable Care Act repeal attempts, few could argue that 2017 wasn’t an eventful year for the health insurance industry.

But 2018 is shaping up to be just as interesting—complete with more political wrangling, M&A intrigue and evidence that, despite all this uncertainty, insurers are pushing ahead and embracing innovation.

Read on for our predictions about what’s in store for the industry in the coming months.

1. The CVS-Aetna deal will have a domino effect in the healthcare industry

While the lines between payer, provider and pharmacy benefits manager have been blurring for a while now, CVS’ $69 billion deal to purchase Aetna is undoubtedly a game-changer.

The move was likely motivated by a desire to compete with UnitedHealth’s thriving Optum subsidiary, which has its own PBM and an increasing presence in care delivery. So it stands to reason that other major insurers will try to strike deals of their own that mimic that scale and level of diversification.

Already, Humana has made a bid to purchase part of hospice- and home-health giant Kindred Healthcare. There’s also been speculation that it is preparing to be acquired—possibly by Cigna, or in a deal that would mimic CVS-Aetna, Walmart or Walgreens.

Other insurers may also seek to build PBM capabilities, following in the footsteps of UnitedHealth, a combined CVS-Aetna and Anthem, which announced in October that it would team up with CVS to create an in-house PBM called IngenioRx.

It’s certainly possible, however, that CVS’ purchase of Aetna will not pass regulatory muster. While it would require less divestment than the ill-fated Anthem-Cigna and Aetna-Humana deals, the DOJ’s decision to block another vertical deal—between AT&T and Time Warner—doesn’t bode well for its chances.

2. Republicans and Democrats will be forced to work together on ACA fixes

With one less Republican senator—thanks to Alabama’s election of Democrat Doug Jones—the GOP likely won’t have the votes to pass a repeal bill without bipartisan support. Senate Majority Leader Mitch McConnell acknowledged as much before Congress’ holiday recess, though he clarified the next day that he would be happy to pass an ACA repeal bill if there are enough votes for it.

McConnell also owes Sen. Susan Collins, R-Maine, as he had promised her he’d pass her reinsurance bill and a bill that would fund cost-sharing reduction payments this year. While Collins held up her end of the bargain—voting for the GOP tax bill—the ACA fixes didn’t make it into the stopgap spending bill Congress passed on Dec. 21.

Democrats, meanwhile, will also be motivated to reach across the aisle. The repeal of the individual mandate will likely put the ACA on more unstable footing, lending more urgency than ever to the task of shoring up the exchanges.

Both parties will also likely face pressure from the healthcare industry’s biggest lobbying groups to get some sort of ACA fix passed. The push to do so, however, will be complicated by the full slate of legislative priorities Congress is facing in the new year, including reauthorizing funding for the Children’s Health Insurance Program.

3. There will be more premium hikes and insurer exits in the individual market

The individual mandate is now gone, and arguments about its effectiveness aside, that was one of the mechanisms that encouraged healthy people to buy insurance and stay covered. Even if the effect on coverage levels is minimal, the move is probably going to be enough to push risk-averse insurers to raise rates and even exit more rating areas in 2019.

There is also little indication that large insurers that have exited will come back anytime soon. After all, why invest resources in an unstable market when there are far more steady and lucrative markets like Medicare Advantage?

Adding to the policy uncertainty for the remaining insurers, there is no guarantee that Congress will authorize short-term funding for cost-sharing reduction payments. Many insurers raised their 2018 rates to account for the possibility of them disappearing—which turned out to be a wise move—so it stands to reason they’d have to do the same for 2019.

Perhaps the best harbinger of what’s to come came from a study conducted in November, which noted that the actions insurers and state regulators took to fill in “bare counties” on the ACA exchanges are “temporary and unsustainable without long-term federal action.” And with Republicans in charge, federal action to patch up the exchanges is unlikely.

4. Federal agencies will start to carry out Trump’s executive order—and states will push back

Although it was overshadowed by all the repeal-and-replace drama, Trump’s healthcare-focused executive order has huge implications for the industry. Put simply, it paves the way for expanded use of association health plans, short-term health plans and employer-based health reimbursement arrangements.

In 2018, we’re likely to see the relevant agencies start issuing rules to implement the order, which could dramatically change the individual market as we know it—and not for the better. Such rulemaking would also set the stage for a power struggle between the federal government and left-leaning states.

In fact, a coalition of healthcare organizations have urged state insurance commissioners to take steps to override any rules resulting from the executive order. For example, states could restore the three-month limit on short-term health plans if agencies unwind that Obama-era rule on the federal level.

Since only certain states are likely to heed these suggestions, the upshot of Trump’s executive order will be to create a patchwork of individual market rules across the country. If that sounds strangely like what the individual insurance markets were like before the ACA, well, that’s precisely the point.

5. Payers’ move to value-based payment models will continue, with or without the feds leading the way

On the one hand, the Trump administration clearly wants to scale back the federal government’s role in pushing payers and providers away from fee-for-service payment models. The surest sign was CMS’ announcement late last year that it would endmandatory bundled payment models for hip fractures and cardiac care.

Some have worried that moving away from those mandatory programs would be a setback for the move to value-based payments, given that the feds play a powerful role in galvanizing the industry to change. In addition, the administration wants to take the Center for Medicare and Medicaid Innovation in a “new direction”—one that CMS Administrator Seema Verma said would “move away from the assumption that Washington can engineer a more efficient healthcare system from afar.”

But even if the federal government will take a lighter touch in the move from volume to value, it’s not likely that the private sector will take that as a cue to reverse course. On the payer side, especially, too many industry-leading companies have invested heavily in alternative payment models to turn back now. And they have compelling business reasons to keep investing in those models, given their potential to lower costs and improve care quality.

 

Children’s Health Insurance Program Still in Limbo After Yet Another Patch

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https://www.bloomberg.com/news/articles/2017-12-21/children-s-health-insurance-gets-yet-another-patch-in-house-bill

Image result for Children’s Health Insurance Program Still in Limbo After Yet Another Patch

  • States running out of money after failure to reauthorize CHIP
  • Bill provides $2.85 billion meant to last through March

A critical government program that provides health-care coverage to 9 million low-income kids received yet another patch to help stretch it out a few more months — with still no long-term fix in sight.

Congress passed short-term legislation Thursday night that includes $2.85 billion to help fund the program, known as CHIP, through the end of March. The measure will help cover the estimated 1.9 million children across 24 states and Washington, D.C., that stood to lose coverage for care such as doctors visits and hospitalizations in January as states have dipped into reserve funds. But the temporary relief still leaves CHIP and families that rely on it in a state of uncertainty.

“You can’t run an insurance program this way,” said Sara Rosenbaum, a professor at the Milken Institute School of Public Health at George Washington University. Lawmakers are forcing health officials who run the program “to go month-to-month.”

Funding for the Children’s Health Insurance Program lapsed at the end of September when lawmakers couldn’t reach agreement on a five-year reauthorization of the program. They’ve since failed to come up with a solution and instead passed short-term fixes — even though CHIP is one of the few programs that enjoys bipartisan support. Both Republicans and Democrats have disagreed on how to pay for a full reauthorization.

“We share a commitment to extend full funding for CHIP as soon as possible,” Senate Finance Committee Chairman Orrin Hatch, a Republican, and Senator Ron Wyden, the top Democrat on the committee, said in a joint statement.

The spending legislation passed Thursday is part of a last-ditch proposal that keeps the government open through Jan. 19 while a longer-term budget solution is worked out. Both the House and Senate approved the spending measure before government-wide funding expired Friday.

Hard on Families

CHIP, created in 1997, is a shared federal-state program for children of parents who can’t afford private insurance but make too much to qualify for the Medicaid government program for the poor. States have broad discretion in setting eligibility, and have the option to cover pregnant women as well.

Funding for CHIP — which also covers dental care and prescriptions, among other services — amounts to almost $16 billion, with more than 90 percent coming from the federal government.

Even with passage of another patch, the limbo is hard on families.

“It’s a pretty bad Christmas or holiday present for a lot of families,” said Diane Rowland, executive vice president of the Kaiser Family Foundation, a bipartisan nonprofit focused on national health issues. “You can predict that there will be relief that the funding has been extended, but it will be combined with a lot of anxiety.”

As for states that can’t plan ahead, “this is creating an administrative nightmare,” Rowland said.

States have to start preparing for a possible shutdown of the program well before the day comes when they run out of money.

‘Stress and Turmoil’

“This whole situation is causing chaos,” said Cathy Caldwell, director of the bureau of Children’s Health Insurance with the Alabama department of public health. “We are causing confusion to families, stress and turmoil.”

Alabama health officials were forced to warn on Dec. 15 they would stop taking new enrollees on New Year’s Day and that the 84,000 children currently in the program could lose coverage Feb. 1.

Democrats have opposed a House GOP proposal to reauthorize CHIP for five years because it would be paid for by taking money from a fund set up under Obamacare to invest in prevention efforts. Bipartisan talks with the Senate and the White House on other funding offsets are “well down the road,” said House Minority Leader Nancy Pelosi, a California Democrat.

 

What is CHIP? 7 things to know about the Children’s Health Insurance Program

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http://www.ajc.com/news/health-med-fit-science/what-chip-things-know-about-the-children-health-insurance-program/yRU5elqPuB7VwIgm3FFNNL/

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Amid efforts to unsuccessfully repeal and replace the Affordable Care Act in the fall, lawmakers let the Children’s Health Insurance Program (or CHIP) to expire on Sept. 30.

And now, doctors and patients are worried that money for the program, which provides 9 million kids across the country with low-cost health insurance, will run out.

In fact, according to the Kaiser Family Foundation, 16 states expect to run out of CHIP reserve funds by the end of January, and three-quarters of the states expect to run out by March.

Here are 7 things to know about CHIP:

What is CHIP?

According to HealthCare.gov, CHIP is a no-cost or low-cost health insurance program that provides coverage to children in families that earn too much money to qualify for Medicaid, but who can’t afford private coverage.

The program is funded by both states and the federal government, but it is state-administered, meaning each state sets their own guidelines on eligibility and services.

In Georgia, the CHIP program is PeachCare for Kids.

CHIP’s history

In 1997, Congress passed Title XXI of the Social Security Act, which enabled states to create programs for the growing number of uninsured children in the country.

The program was created during the Clinton administration by the Balanced Budget Act of 1997. At the time, 10 million children were without health insurance and many of those children were part of working families with incomes slightly above states’ Medicaid eligibility levels, according to the Medicaid and CHIP Payment and Access Commission.

The Children’s Health Insurance Program Reauthorization Act (CHIPRA) reauthorized CHIP in April 2009.

The next year, the Affordable Care Act contained provisions to strengthen the program and later extended CHIP funding until September 30, 2015. It also required states to maintain eligibility standards through 2019.

By 2015, 18 years after its enactment, 3.3 million children in the U.S. were without health insurance.

In October 2017, however, Congress missed a deadline to reauthorize CHIP, which expired on Sept. 30.

“Lawmakers and staffers in Congress say CHIP funding will likely be included in an end-of-year spending bill,” NPR reported Tuesday. “But as of now, there is no CHIP funding bill scheduled for consideration.”

Who is eligible for CHIP?

Eligibility varies by state, but in most states, children up to age 19 with a family income up to $49,200 per year (for a family of four) may qualify for Medicaid or CHIP, according to insurekidsnow.gov.

But even if your family income is higher, children may still qualify.

Some states (Colorado, Missouri, New Jersey, Rhode Island and Virginia) also provide coverage to pregnant women through CHIP.

Coverage is for U.S. citizens and certain lawfully present immigrants.

What does CHIP cover?

State benefits may vary, but all states provide comprehensive coverage for routine check-ups, immunizations, doctor visits, prescriptions, dental/vision care, inpatient /outpatient hospital care, laboratory/X-ray services and emergency services.

How much does CHIP cost?

The cost depends on family income. Many families may get free health insurance coverage for their kids and others may have to pay a modest enrollment fee or premiums, as well as copayments for specific services.

But according to healthcare.gov, you won’t have to pay more than 5 percent of your family’s income for the year.

How do you apply for CHIP?

There are three ways to apply. You can either call 1-800-318-2596 (1-855-889-4325 for TTY), fill out an application through the health insurance marketplace or apply directly with your state’s CHIP agency.

How many children get health insurance from CHIP?

Nine million kids get health insurance under CHIP.

The CHIP Program Is Beloved. Why Is Its Funding in Danger?

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Laquita Gardner, a sales manager at a furniture rental store here, was happy to get a raise recently except for one problem. It lifted her income just enough to disqualify her and her two young sons from Medicaid, the free health insurance program for the poor.

She was relieved to find another option was available for the boys: the Children’s Health Insurance Program, known as CHIP, that covers nearly nine million children whose parents earn too much for Medicaid, but not enough to afford other coverage.

But CHIP, a program that has had unusually strong bipartisan support since it was created in 1997, is now in limbo — an unexpected victim of the partisan rancor that has stymied legislative action in Washington this year. Its federal funds ran out on Sept. 30, and Congress has not agreed on a plan to renew the roughly $14 billion a year it spends on the program.

“I’m kind of shocked, because this is something for kids,” Ms. Gardner said Thursday as her 7-year-old, Alexander, braced for a flu shot at a bright, busy neighborhood clinic run by the Nemours Children’s Health System. Ms. Gardner pays $25 a month for her sons’ CHIP coverage, with no deductible or co-payments.

Congressional leaders may provide some temporary relief to a handful of states that expect to exhaust their CHIP funds before the end of this year. It would be tucked into a short-term spending bill intended to avert a government shutdown after Friday. Lawmakers from both parties hope to provide more money for CHIP in a separate, longer-term deal on federal spending. But Republicans will almost surely need Democratic votes to pass such legislation, and the antagonism between President Trump and Democrats in Congress is so great that no one can be sure of the outcome.

The uncertainty has been unsettling to parents, pediatricians and state officials around the country. States are weighing whether to freeze enrollment in CHIP, shut down their programs or find money from other sources. Last week Colorado sent letters to CHIP families, advising them to start researching private health insurance options because there was “no guarantee” that Congress would continue the program. Texas has drawn up a detailed “termination timeline” under which the state could begin mailing insurance cancellation notices on Dec. 22, three days before Christmas.

“It crushes me to think we’re in an environment where kids’ health is up for debate — that this somehow got tossed into the wrangling,” said Dr. Todd Wolynn, a pediatrician in Pittsburgh and a member of the American Academy of Pediatrics. “There are kids on protocols and regimens and treatment plans, and their families have got to try to figure out, what are we going to do?”

Here in Delaware, health officials anticipate running out of money for CHIP at the end of January if Congress does not act.

“I’ve been around a while and I’ve never seen a program that is this popular, and that goes across the aisle,” said Stephen Groff, director of the state’s Division of Medicaid and Medical Assistance. “To be having this discussion, that we may be in a funding crisis, is beyond belief.”

Members of both parties in the House and the Senate agree that Congress should provide money for CHIP for five years, through 2022. But they disagree over how to pay for it.

In early November, the House passed a bill to extend the CHIP program. But most Democrats voted against it because the legislation would have cut funds for other public health programs and ended insurance coverage for several hundred thousand people who had failed to pay their share of premiums for insurance purchased under the Affordable Care Act.

In the Senate, senior members of the Finance Committee say they have been making progress toward a bipartisan deal on CHIP, but they have been preoccupied for several weeks with their tax bill. The committee approved a five-year extension of funding for the program in early October, but did not specify a way to pay for the measure.

As Congress dithered, Minnesota received an emergency infusion of federal funds to continue CHIP for October and November, but is expected to be the first state to run out of federal money for the program. Emily Piper, the commissioner of the Minnesota Department of Human Services, said the state would use its own funds to fill the gap temporarily.

“I don’t think Washington is working the way anyone in the country expects it to work right now,” she said. “A dysfunctional Washington has real consequences for people.”

Oregon, which expects to exhaust its federal CHIP funds this month, will also use state funds to continue coverage, said Gov. Kate Brown, a Democrat. “As Congress rebuffs its responsibilities, it is up to us, Oregonians, to stand up for our children,” she said.

Colorado was the first state to send warning letters to families with CHIP coverage. “We felt it was important that folks covered by CHIP understand what’s happening,” said Marc Williams, a spokesman for the state Department of Health Care Policy and Financing.

In Texas, more than 450,000 children could lose CHIP coverage on Feb. 1 unless the state can obtain $90 million. Even if it comes through, supporters of the program worry about the effect of cancellation warnings.

“It gets very, very complicated once the state sends those letters out and starts walking down that road,” said Laura Guerra-Cardus, deputy director of the Children’s Defense Fund-Texas. “It can really affect trust in the program. So many families still don’t realize this is coming, and the few I’ve informed, they go immediately into a state of alarm.”

Representative Greg Walden, Republican of Oregon and the chairman of the Energy and Commerce Committee, which is responsible for the program, said last week that “we need to get CHIP done” because “states are in a real mess right now.”

Democrats said Congress should have provided money for CHIP months ago, but that Republicans had placed a higher priority on dismantling the Affordable Care Act and cutting taxes.

“Because Congress failed to do its job — a bunch of elected officials who have insurance paid by taxpayers failed to do their job — children here in America are about to be kicked off of their health insurance,” said Senator Sherrod Brown, Democrat of Ohio.

Senator Orrin G. Hatch, Republican of Utah and the chairman of the Senate Finance Committee, insisted: “We’re going to get CHIP through. There is no question about that.”

Mr. Hatch led efforts to create the program in collaboration with Senator Edward M. Kennedy, Democrat of Massachusetts, in 1997. “Nobody believes in the CHIP program more than I,” Mr. Hatch said on the Senate floor last week. “I invented it.”

Doctors at the Nemours/Alfred I. duPont Hospital for Children, here in Wilmington, were continuing to see CHIP patients last week at the flagship of a system that treats 15,000 children with CHIP coverage each year. Dr. Jonathan Miller, chief of the system’s Division of General Pediatrics, said many receive therapy for developmental delays and treatment for chronic conditions like asthma and obesity.

“It provides specialized care for children that’s more comprehensive than a lot of private coverage,” he said, “which is really designed with adults in mind.”

Research has also found CHIP increasingly helps people whose employer-provided insurance is too expensive for their entire family. Ariel Haughton, a mother of two in Pittsburgh, said it would cost more than $100 more a month to put her two children on the plan her husband gets through his job as an apprentice plumber, which also requires them to pay a high deductible before the coverage kicks in. Without CHIP, Ms. Haughton said, she might have delayed visiting the pediatrician this summer when her daughter had a fever and rash that turned out to be Lyme disease.

“It makes it so much easier for me to actually take good care of my children,” said Ms. Haughton. “We’ve had a rocky last few years, but at least I can take them to the doctor without having to be like, ‘Their fever isn’t 105 so I guess I’d better skip it.’”

Olivia Carrow, who had brought her 2-year-old to the children’s hospital here to test for an infection, said her other three children were newly uninsured and she had heard they might qualify for CHIP. The 2-year-old, William, qualifies for Medicaid because of a serious condition that causes his trachea to collapse.

The rest of the family had insurance through Ms. Carrow’s job as a nurse, but lost it after she cut back her hours this fall. She and her husband started a chicken farm this year and delayed exploring other coverage options, she said, partly because of the protracted fight in Congress over proposals to repeal the Affordable Care Act.

“Not knowing how things are going to go — I feel that way about health coverage in general,” Ms. Carrow said. “It doesn’t surprise me, but it gets very sad.”

 

Congress floats temporary patch for CHIP funding shortfalls

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https://www.fiercehealthcare.com/cms-chip/congress-floats-temporary-patch-for-chip-funding-shortfalls?mkt_tok=eyJpIjoiTkdKallqUmhOV1prTmpZMyIsInQiOiIzV0NnWXA2amJKeHRybHVFTWl3bCtXMHpQXC92SXRnZyt0WGV0VFFUTkxoQk1UTHlyMGRlTFZkc3V2aXM0cGY5Q1Fndmh0ck5venI0OVJVMWhpNHQrakJWSytReEVBc2N4Y1lwRXBHQmZ2RGR6bk9cLzJxREZIbDk2VWQ2bzFKSmZvIn0%3D&mrkid=959610&utm_medium=nl&utm_source=internal

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In its short-term appropriations bill, Congress has included a provision aimed at helping states keep their Children’s Health Insurance Programs afloat while lawmakers try to pass a longer-term measure. But that gesture may not go nearly far enough.

The bill would direct the secretary of Health and Human Services to allocate previously unused CHIP funding first to “emergency shortfall states”—or ones that are in danger of running out of money—before other states. The federal government has already been redistributing funding from past years to states that were facing shortfalls in October and November.

Those shortfalls exist because federal funding for CHIP expired Sept. 30, and Congress’ efforts to pass funding reauthorization measure have been stalled by partisan disputes over how to pay for it. The Senate Finance Committee has advanced its version of a CHIP bill—which doesn’t outline any offsets—while a companion bill, containing cuts to other healthcare programs, cleared the House despite Democrats’ objections.

If Congress fails to pass a long-term CHIP funding measure, at least five states and the District of Columbia predict they will run out of money for the program by the end of 2017 or early in January, according to a survey from the Georgetown University’s Center for Children and Families. Some states have already sent notices to families advising them to start researching private health insurance options.

The center’s executive director, Joan Alker, also isn’t impressed by the CHIP provision in the short-term appropriations bill, calling it a sign Congress is trying to “kick the can down the road.”

“The longer Congress postpones action on long-term CHIP funding, the more states will be forced to waste time and money developing contingency plans,” she wrote in a blog post, adding, “the more states that send out notices, the more likely it will be that some kids will fall through the cracks.”

Healthcare Triage News: Lots of Children Are About to Lose Their Health Coverage

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Healthcare Triage News: Lots of Children Are About to Lose Their Health Coverage

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Budget authorization for the Children’s Health Insurance Program in the US ran out a couple of months ago, and there’s no reauthorization in sight. A LOT of kids are insured through this program.

Five health-care fights facing Congress in December

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Five health-care fights facing Congress in December

Five health-care fights facing Congress in December

Health-care issues are at the top of Congress’s hefty December to-do list.

Republicans spent much of the year on a failed bid to repeal and replace ObamaCare. That’s left several programs and taxes hanging in the balance as the year draws to a close, in addition to the latest health-care drama thrust into the GOP tax-reform debate.

Here are five of the biggest health-care issues Congress will face next month.

Will Republicans repeal the individual mandate?

Weeks ago, Sen. Tom Cotton (R-Ark.) began to push for a repeal of the individual mandate to be added into the GOP tax overhaul. It worked, at least in the upper chamber.

To Democrats’ dismay, the Senate Finance Committee passed a tax-reform bill before breaking for Thanksgiving that included repeal of the ObamaCare mandate that Americans without health insurance pay a fee.

The House already passed a bill out of its chamber on a party-line vote — legislation that didn’t include repealing the individual mandate. But leaders have said they’re open to it if the Senate is able to muster enough votes to pass tax reform with the repeal.

It appears that the upper chamber might be able to pull it off.

Sen. Susan Collins (R-Maine) has said the repeal shouldn’t be in the bill, but hasn’t said she would vote against the tax-reform bill if it was included. Sen. John McCain (R-Ariz.) hasn’t rung any alarms that he would vote against the bill, saying he wants to see the whole package before deciding, and applauding the Finance Committee for holding hearings on the measure.

In a boost to the effort, Sen. Lisa Murkowski (R-Alaska) wrote in the Fairbanks Daily News-Miner Tuesday that she backs repealing the individual mandate. All three senators voted against a scaled-down version of an ObamaCare repeal bill in late July, effectively sinking the measure.

GOP leaders have signaled that a bipartisan stabilization bill from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) could pass if the individual mandate is repealed. On Sunday, Collins said she would like the Alexander-Murray bill, along with a bipartisan bill to provide funding for high-cost enrollees she introduced, to pass before tax reform does.

Sen. John Cornyn (Texas), the Senate’s No. 2 Republican, said that the deal is “likely” to be included in an end-of-the-year package.

But that effort could face resistance from Democrats, who have balked at repealing the individual mandate, and say that runs counter to the bipartisan spirit that Alexander-Murray was crafted under.

Will Congress reauthorize critical health programs it let lapse?

It’s been nearly two months since funding for the Children’s Health Insurance Program (CHIP) and community health centers expired. Advocates are holding out hope that lawmakers will reauthorize both before the new year, but are frustrated that Congress failed to reauthorize the dollars by a Sept. 30 deadline.

Roughly 9 million low- and middle-income children rely on CHIP for health coverage. Some states have asked the Centers for Medicare and Medicaid Services for funding to hold them over in the interim, and the agency has awarded about $607 million in redistributed funds to states and U.S. territories.

Community health centers have been crafting contingency plans as they wait for Congress to reauthorize a fund that amounts to 70 percent of their federal funding. These centers are a large source of comprehensive primary care for over 26 million of the nation’s most vulnerable people.

Some have already instituted hiring freezes. Others are examining which services they could cut or scale back. If the funding lapses, staff could be laid off, facility renovations or expansions could be canceled or delayed and hours of operation could be reduced.

Though the uncertainty has caused angst for health centers, they haven’t yet seen a monetary impact. But that impact could come on Jan. 1 for 25 percent of centers and on Feb. 1 for another 17 percent, because that’s when their new grant periods begin.

The Health Resources and Services Administration plans to help out on a prorated, monthly basis, according to a spokesperson.

But advocates hope it won’t come to that. The House passed a bill to fund CHIP for five years and community health centers for two. It passed on a party-line vote, as Democrats criticized how Republicans planned to pay for the bill.

The Senate Finance Committee passed a bipartisan, five-year CHIP extension, but hasn’t yet released offsets. Sens. Debbie Stabenow (D-Mich.) and Roy Blunt (R-Mo.) have introduced a bipartisan bill to extend community health center funding for five years.

Will Congress fund the opioid response?

In late October, President Trump declared the opioid epidemic a national public health emergency.

But the move didn’t come with millions of new dollars to combat the crisis, nor did it include a funding ask to Congress. This has frustrated Democrats and many advocates, who say a significant infusion of federal funds is needed to make an emergency declaration effective.

It’s not clear if money will come.

Senate Democrats introduced a bill to provide $45 billion over 10 years to address the crisis — a nod to a similar amount of funding Republicans included in an ObamaCare repeal bill, in part to attempt to offset changes to Medicaid.

But Republicans haven’t named a dollar figure. With a jam-packed December, advocates worry the new year could begin without more money to help curb the crisis of prescription painkillers and heroin that’s ravaged the country.

As for the administration, Hogan Gidley, White House deputy press secretary, said in a statement that “we will continue discussions with Congress on the appropriate level of funding needed to address this crisis” but didn’t say how much that would be.

What does Congress do on ObamaCare taxes?

Behind the scenes, industry lobbyists are working hard to ensure several ObamaCare taxes won’t kick in come January.

The medical device industry wants a full repeal of a 2.3 percent tax on the sale of certain medical devices, such as pacemakers and MRI machines.

“We feel we’re very much in play and that is for full repeal,” said Greg Crist, a spokesman for the medical device trade association AdvaMed. “We’re talking with staff and leadership for the right vehicle.”

The insurance industry is pushing for at least a one year delay of the health insurance tax. Both taxes were delayed in a 2015 spending bill, though for different durations; the medical device tax was paused for two years, and the health insurance tax for just 2017.

Ways and Means Chairman Kevin Brady (R-Texas) addressed the ObamaCare taxes during a marathon hearing on House Republican’s tax-reform bill, saying the legislation wasn’t the right vehicle to repeal or delay them. But, he added, he is working to do so by the end of the year.

“As the ranking member and members on both sides of the aisle know — we have been working with them over the past month to find a path forward,” Brady said. “We are working on common-sense temporary and targeted relief from many of these taxes to be acted on in the House before the end of the year.”

Employer groups are also pushing for a delay of the so-called Cadillac tax, a 40 percent fee levied on pricey employer-sponsored plans slated to begin in 2020. Critics of the tax argue a delay is needed now because employers will begin planning for 2020 next year.

Will Congress help Puerto Rico fund its Medicaid program?

The storm-ravaged island territory could be out of federal dollars for its Medicaid program in a matter of months.

Federal disaster funds haven’t been earmarked to go to the joint state-federal health insurance program for low-income and disabled Americans. On Nov. 17, the White House asked Congress for $44 billion for disaster relief. The notice mentioned Puerto Rico’s Medicaid program, but didn’t put a dollar amount on it.

“Though the Administration expects to work with Puerto Rico and the Congress on medium-term liquidity issues through a future request, the Administration is aware of legislation being considered to address Medicaid sooner,” the letter stated.

Puerto Rico Gov. Ricardo Roselló has asked for $1.6 billion annually for five years. Democratic lawmakers and advocates have been pushing to fulfill that request.