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The Health 202: Members of Congress no longer have any excuse not to reauthorize CHIP


with Paulina Firozi


9 million children and 370,000 pregnant women could see the end to their health insurance, if lawmakers don't act. (Video: Joyce Koh/The Washington Post)

Now there is really, truly no excuse for Congress to let health insurance for 9 million low-income kids collapse.

More than 100 days after the Children’s Health Insurance Program expired, the reason behind why lawmakers haven’t reauthorized it — disagreements over financing — has crumbled. The wonky new reality is that reauthorizing CHIP saves money instead of costing money, per a new projection this week from the Congressional Budget Office.

You heard that right. Lawmakers no longer have to pay for reauthorizing CHIP, as long as they expand the time frame in which they extend it from five years to seven or more. This means it would be shocking — truly shocking — if Congress still didn’t provide the popular bipartisan program with the financial certainty states need to maintain coverage for kids who need it.

Sen. Ron Wyden (D-Ore.): 

“The committee is confident that a long-term CHIP funding extension…will soon be signed into law,” a Republican spokeswoman for the House Energy and Commerce Committee said. “Children and their families can’t wait any longer.”

Here’s the quick backstory. Funding for the state-run CHIP program technically expired at the end of September, although states had some leftover funds to tide them over. The House passed a reauthorization bill in November, but the Senate never acted. Then, in last month’s agreement to keep the government open, Congress approved six months of funding for the program that was technically supposed to fill the gap until the end of March. But it turns out that funding isn’t quite enough for some states.

Now all eyes are on Jan. 19, which is the next deadline for Congress to fund the government. There has been talk of including CHIP in that package or doing it separately later, although aides and lobbyists emphasize everything is up in the air, and lawmakers are still absorbing the new CBO projection.

Either way, states are deeply troubled at how long the situation has gone on, as they’re the ones who are responsible for severing low-income children from their health coverage once they run out of money. Both parties are urging a quick reauthorization, even though Democrats have dug their feet in the sand against the GOP’s proposed funding sources and Republicans have appeared unwilling to compromise.

Sen. Patty Murray (D-Wash.): 

Sen. Jeff Merkley (D-Ore.): 

From the Southern Poverty Law Center:


Sen. Ed Markey (D-Mass.): 

The Childrens Defense Fund: 

In a roundabout way, which Republicans probably didn’t even realize at the time, they were the ones who sparked the conclusion that should, theoretically, make it much, much easier to pass a CHIP bill.

Weirdly, it’s all because they repealed the Affordable Care Act’s individual mandate in the Republican tax overhaul that passed at the end of last year.

To summarize the CBO’s complicated line of reasoning that led to this outcome, no mandate means fewer people will enroll in the Obamacare marketplaces, meaning fewer low-income folks will get federal subsidies. Some of those people leaving the marketplaces would instead enroll their kids in CHIP. And on the federal government’s end, paying for CHIP coverage is actually cheaper overall than funding subsidies for private marketplace plans.

So the government, the argument goes, would actually saves money on CHIP in the future. The CBO estimates that reauthorizing CHIP for a decade would save $6 billion.

“This should be a no-brainer – we should stop the uncertainty and permanently extend CHIP,” Rep. Frank Pallone, top Energy and Commerce Committee Democrat, said in a statement.

For states, it’s pretty much a code red situation. Late last week, the Centers for Medicare and Medicaid Services said that the short-term funding lawmakers have provided for CHIP may not last through the end of March because of difficulties in predicting spending rates.

“Due to a number of variables relating to state expenditure rates and reporting, we are unable to say with certainty whether there is enough funding for every state to continue its CHIP program through March 31, 2018,” said CMS spokesman Johnathan Monroe.

Before Congress approved short-term CHIP funding in December, several states had prepared or were preparing to notify CHIP-enrolled families that their coverage could soon end. State officials still face the tricky question of when to notify enrollees their insurance is about to get snuffed out.

Teresa Miller, Pennsylvania's acting Health Services secretary, told me she’s been grappling with the dilemma over exactly when to send out notices, as Congress has continued promising to fund CHIP but has dragged its feet.

If you send notifications too late in the process, families may not have sufficient time to prepare for their coverage ending.

But if you mail notices too early – and Congress reauthorizes the program at the last possible second (which, let's face it, is a real possibility) – then families are saddled with needless worry and may even stop using health-care services because they think their coverage has lapsed.

“Sending letters saying your coverage is going to end for your kids – that is not a letter I want to send until I absolutely have to,” Miller said.


AHH: The Trump administration sent a letter to states this morning offering guidance for how they can start mandating work for able-bodied adults on Medicaid, a requirement previously prohinited by the Obama administration but which nearly a dozen states are requesting, The Post's Amy Goldstein reports. 

The guidance from the Centers for Medicare and Medicaid Services gives states a great deal of flexibility to define a work requirement, saying such activities “include, but are not limited to, community service, caregiving, education, job training, and substance use disorder treatment." It specifies only that “medically frail” people be exempt and that people with opioid addiction be either exempted or allowed to count time in drug treatment toward work activities. It also suggests that states take into account the local availability of jobs in creating requirements, Amy reports.

"The letter to state Medicaid directors opens the door for states to cut off Medicaid benefits to Americans unless they have a job, are in school, are a care-giver or participate in other approved forms of “community engagement” — an idea that some states had broached over the past several years but that the Obama administration had consistently rebuffed," Amy writes.

"The new rules come as 10 states are already lined up, waiting for federal permission to impose work requirements on able-bodied adults in the program...Health officials could approve the first waiver — probably for Kentucky — as soon as Friday, according to two people with knowledge of the process," she continues. "The guidance represents a fundamental and much-disputed recalibration of the compact between the government and poor Americans for whom Medicaid coverage provides a crucial pathway to health care."

OOF: Federal health officials have frozen a registry of hundreds of mental health and substance-abuse programs intended to help professionals and community groups find evidence-based treatment, The Post's Lena H. Sun and Juliet Eilperin report.

The National Registry of Evidence-based Programs and Practices (housed within the Health and Human Services Department’s Substance Abuse and Mental Health Services Administration) offers a database of treatment programs that have been assessed by an independent contractor and deemed scientifically sound. Mental health and addiction specialists say they rely on this database as a key source for finding appropriate and effective therapies, Lena and Juliet report.

"Agency officials froze the existing website in September, and no new postings have been added, according to mental health advocacy groups," Lena and Juliet write. "As a result, about 90 new programs that have been reviewed and rated for their scientific merits since September are not available to the public."

Administration officials confirmed the contract for running the database has been terminated and a new entity will take over the program’s duties. Agency spokesman Brian Dominguez said the new entity is “working closely” with other parts of the agency to “institute an even more scientifically rigorous approach to better inform the identification and implementation of evidence-based programs and practices," but officials declined to say why the registry was suspended, nor did they give specifics about how the new approach will work, when it will launch or whether existing validated programs will be included.

OUCH: Yet another insurance giant is bidding farewell to the influential industry lobbying group America's Health Insurance Plans. Humana has announced it will leave AHIP, in another blow to the top insurance lobby after Aetna and UnitedHealth took their leave in 2015. Humana told the Washington Examiner it had not actively participated in AHIP since early 2017. 

AHIP spokeswoman Kristine Grow insisted the decision was based on business “as opposed to any difference in policy.” The association noted it added a dozen new members last year and said many top insurers are still members.

FierceHealthcare also noted Humana’s exit from AHIP comes amid reports the company could be part of a future acquisition by another insurer or a pharmacy giant such as Walmart, in part as a response to CVS Health’s merger with Aetna.


--Sen. Bob Casey (D-Pa.) has obtained a one-page document from the Trump administration listing ten executive actions officials planned to take to "improve the individual and small group markets most harmed by Obamacare." The March 23 document outlines the route top HHS officials were planning to undermine the ACAt using executive authority, even as their GOP counterparts on Capitol Hill were working to repeal it.

The proposed executive actions include halving the ACA sign-up period one year before the Obama administration's aim; requiring stricter verification of people who try to sign up outside of the open enrollment period; and giving states authority to determine whether insurers had to cover the full range of health benefits required by Obamacare. The administration has since implemented seven of its proposals.

Casey said he'd threatened holds on several Trump nominees in order to obtain the document from HHS. “From day one, the Trump administration has had a maniacal obsession to try to decimate the Affordable Care Act,” Casey said in a statement. “This secret document demonstrates how far the administration and Congressional Republicans are willing to go, engaging in slimy backroom deals, to further their sabotage agenda.”


--A senator critical to getting Trump's HHS nominee Alex Azar confirmed -- Democrat Joe Manchin of West Virginia -- says he's on board. Manchin’s office confirmed his support for Azar yesterday, the Washington Examiner reported. The red state senator's support on several issues are key for Republicans, who now hold just a 51-49 margin in that chamber with the election of Alabama Sen. Doug Jones, a Democrat. So far Manchin is the only Democratic senator to publicly announce his support for Azar.

--House Speaker Paul Ryan (R-Wis.) will speak at the Jan. 19 March for Life rally in Washington, one of several lawmakers who will address the annual event to protest the Supreme Court's Roe v. Wade ruling legalizing abortion.

“Speaker Ryan has been an unwavering champion for the pro-life cause since taking office, and continues to utilize his post to promote the inherent dignity of the human person at all stages of life,” March for Life President Jeanne Mancini said in a statement yesterday.

Other speakers include Republican Reps. Jaime Herrera Beutler (R-Wash.) and Chris Smith (R-N.J.), but also Democratic Rep. Dan Lipinski (D-Ill.), along with Heritage Foundation President Kay Cole James and Pam Tebow, mother of former NFL player Tim Tebow. 

--A few more good reads from The Post and beyond:

Trump says he’s a stable genius. Only a quarter of Americans agree. (Philip Bump)

Trump Officials, After Rejecting Obama Medicare Model, Adopt One Like It (New York Times)

New marijuana crackdown policy could become election-year headache for GOP (Karen Tumulty)


The rural-urban sex divide in three simple charts (Ariana Eunjung Cha)

Too many black women like Erica Garner are dying in America’s maternal mortality crisis (Vox)


South Dakota will seek work requirements for some Medicaid recipients (The Hill)



  • The National Academy of Sciences workshop on "The Promise of Genome Editing Tools to Advance Environmental Health Research” continues. 

Coming Up

  • MedPAC holds a public meeting on Thursday and Friday.
  • The Bipartisan Policy Center holds a discussion on “Reinventing Rural Health Care: A Case Study of Seven Upper Midwest States” on Jan. 17.
  • The House Veterans’ Affairs Subcommittees on Health and on Economic Opportunity hold a joint hearing on addressing veteran homelessness on Jan. 18.
  • Kaiser Health News holds an event on what’s in store for health care in 2018 on Jan. 18. 

Trump vows to reexamine libel laws: 

At his first cabinet meeting of 2018, President Trump promised to reexamine libel laws, saying that they aren't strong enough. (Video: The Washington Post, Photo: Jabin Botsford/The Washington Post)

At the European premiere of "The Post," actor Tom Hanks criticizes those who are "delegitimizing" the free press:

Actor Tom Hanks spoke about the animosity between President Trump and the media while at the European premiere of "The Post" in London on Jan. 10. (Video: Reuters)

Samantha Bee says there's "no country for pregnant women:" 

Watch Jimmy Kimmel on "Trump's 2,000 lies:"