For all the handwringing about what the new Republican-controlled Congress could to do Obamacare, another health insurance program could be dropped entirely if lawmakers don't take action this year: the Children's Health Insurance Program.
The program covers an estimated 8 million children in low- and middle-income families that earn too much to qualify for Medicaid. Funding is set to expire in September, and it's not clear yet if the new Congress will extend CHIP or scale it back. Those who get dropped will probably have to go on to the new health insurance exchanges for coverage, but one estimate found as many as 2.7 million children could still lose health insurance if CHIP goes away this year.
There's one state that's already gotten rid of CHIP, though: Arizona. And the state's experience offers some ominous lessons for what can happen to families if they lose assistance, according to Georgetown University researchers in new reports.
Of the 37,000 Arizona children who lost CHIP coverage last year, about 23,000 were transferred into the state's Medicaid program. It's unclear how many of the remaining 14,000 children obtained insurance through the state's Obamacare exchange or found another source of coverage.
It appears, though, that there was at least some kind of bump into the exchanges. Notably, about 21 percent of people who signed up for exchange plans in Arizona last year were under 18 years of age, the highest percentage of any state and much more than the 6 percent national average. (Of course, it's not clear how many of those were previously enrolled in CHIP).
But children's health advocates are concerned that exchange coverage isn't nearly as good for children. In a previous analysis, Georgetown researchers found that former Arizona CHIP enrollees switching over to the exchange likely would have to buy coverage that was anywhere between two and eight times more expensive and with fewer benefits. The poorest families and those with more than one child would face the largest cost increases, even with subsidies, because of the exchange plans' high out-of-pocket costs, they found.
And the exchanges could become even less attractive if the Supreme Court rules this summer that the health-care law doesn't provide health insurance subsidies in the 37 states that declined to set up their own marketplaces.
Created in 1997 with bipartisan backing from Sens. Orrin Hatch (R-Utah) and the late Ted Kennedy (D-Mass.), CHIP is credited with cutting the children's uninsured rate in half to 7 percent during that time. The joint state-federal program cost $13 billion last year, with states having flexibility to design their CHIP programs.
It seems that there is widespread bipartisan backing for at least temporarily extending the program. Last month, 39 governors went on record to support a CHIP extension. Hatch, now the chairman of the Senate Finance Committee, on Tuesday called extension of CHIP a top priority.
There's disagreement among CHIP supporters on how long to extend the program, and whether it should eventually end since the Affordable Care Act health insurance exchanges help close a coverage gap. A long-term discussion over scaling back CHIP will likely hinge on reforming the benefit packages available for children's coverage through exchange health plans.
In a new era of expanded coverage, it seems that cutting CHIP would make children the only group of Americans to see less coverage, not more.