When people think about pediatric health care, they often conjure up visions of healthy children running and playing or maybe of them sitting on an exam table getting an immunization. Those who have experience with children’s hospitals may envision a child receiving chemotherapy or a premature baby in an incubator. And if asked to picture under-insured kids, it would be likely they would think of developing countries half a world away. It is doubtful they would think of children living in the United States.
However, there are significant numbers of children living in this country who are under-insured and many more who would be without appropriate health care if it were not for federal and state-funded programs like Medicaid and Children’s Health Insurance Program, more commonly known as CHIP. Millions — in fact, just over 50 percent — of children rely on these programs to get even basic health care. The most recent statistics are that close to 35 million children are on Medicaid and another 10 million rely on CHIP funding for care. The plains states have the least numbers of patients on CHIP programs, with around 300,000 kids, or 2.75 percent of their population. California leads the nation with the most children relying on this assistance at 1.3 million children on the program. And since 2013 and the advent of open enrollment, the percentage of children on the rolls of these programs continues to increase.
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Many wonder what the purpose of a program like CHIP adds on top of Medicaid. Specifically, CHIP allows for coverage of dependents up to age 19 whose families are “too rich” to qualify for Medicaid. It also covers certain pregnant females and their newborns and the children of state employees. A central focus of CHIP is in preventative healthcare, the cornerstone of pediatric medicine. It allows for early developmental screening, vaccinations, dental care and behavioral health assessments. It also covers illnesses that all children are likely to encounter in their youth.
Sounds great, right? Caring for our children has after all been a priority for America for centuries. However, the health care of children has become another potential casualty of the political maneuvering in our society. Despite bipartisan promises to pass the legislation that would continue to fund CHIP, there was a lack of urgency regarding getting it done. The program lapsed on Sept. 30, 2017. It seemed to get lost in the efforts of repeal and replace legislation in the months that surrounded the deadline. With many programs in very real danger of closing down and dis-enrolling patients, an emergency package of $2.85 billion was approved, nowhere near the $14.5 billion that has been used in the past. States were using any leftover dollars they had to sustain their programs for as long as they could. A few states, like Minnesota, received emergency funds from the Centers for Medicare and Medicaid to keep things afloat. States were preparing to run out of funds by summer.
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Now picture a family who’s working, trying to make ends meet. They’re staying off Medicaid but aren’t quite in the position to afford health care in the most expensive medical system in the world. Imagine them opening a letter telling them their children are going to be dis-enrolled from their health care plan. What choices does that leave them? Go uninsured? Quit their jobs or get divorced so they qualify for Medicaid? Or hold their breath and hope the government figures it out before something happens to their child?
In the eleventh hour came the reprieve. As part of the negotiation to reopen the government, which had been shut down over partisan disagreements regarding the federal budget and immigration, the CHIP deal finally got funded for 6sixyears. After 114 days of no funding and coming to the brink of dissolution, there was bipartisan support. It’s kind of like a fairy tale — a gruesome road with a moment of salvation at the end. But was it a fairy tale or a near-disaster story? The true tragedy of the CHIP story is that pediatric health is used as a bargaining CHIP in political impasses. While it ended well with significant funding dollars for several years, one has to wonder if children will remain a bargaining chip or if their needs will be addressed for the immense impact their well-being has on society, fundamentally as well as financially.
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The business of politics is complex and difficult to navigate. That has probably been true since the founding fathers had the first arguments over the two-party system and the Constitution. We have come to expect that. Hopefully, we don’t expect children to be a casualty of the system. I doubt any fathers (founding or otherwise) or mothers can accept that their children are part of the bargain and a chip in the game. Maybe none of us should.
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Children’s Health: a Political Bargaining CHIP? originally appeared on usnews.com
