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8 million kids could lose health insurance if the CHIP program isn’t renewed. Here’s what that looks like in one state

Three years ago, Michelle Bell’s son struggled with severe depression and suicidal thoughts. But the working mother in Tupelo, Mississippi, couldn’t afford the help he desperately needed.

As an insurance clerk at a pediatrician’s office, Bell made too much to qualify for Medicaid (“I want to work and earn my way”) yet too little to pay for her company’s health insurance premiums, co-pays and prescriptions.

The cost of residential behavioral treatment in Olive Branch, Mississippi — 86 miles from home — amounted to $1,000 a day for two weeks, far beyond what the family could afford. But in the late 1990s, her son qualified for the Children’s Health Insurance Program, a then-new federal program that provides matching funds to states to cover children whose families aren’t eligible for Medicare but don’t earn enough to pay out of pocket, either.

“If I didn’t have insurance, we would still be paying for it for the rest of our lives,” she said.

Michelle Bell stands with her sons, ages 9 and 19 and her daughter, age 11, during Easter. All of her children have been covered by the Children's Health Insurance Program. Photo courtesy of Michelle Bell

Michelle Bell stands with her sons, ages 9 and 19 and her daughter, age 11, during Easter. All of her children have been covered by the Children's Health Insurance Program. Photo courtesy of Michelle Bell

For the past 18 years, at her job in the pediatrician’s office, Bell has sorted through stacks of medical claims like her own as if she’s solving a puzzle. She thrives on the challenge. Insurance can be tricky to figure out — for her and the families trying to gain or use their coverage, she says. It’s been made more complicated for many families since Congress got sidetracked by efforts to repeal and replace the Affordable Care Act and missed its Oct. 1 deadline to fund CHIP, which covers 8.3 million children nationwide with low-cost health insurance.

As a result, 31 states and the District of Columbia may run out of federal dollars for the program by March 2018. Mississippi is one of them.

Like millions of families who qualify for CHIP, Bell earned too much money to qualify for Medicaid but too little to afford private health insurance premiums for her children, ages 9 and 11. CHIP made health care affordable for Bell’s family, whose kids are among more than 87,000 enrolled children in Mississippi. But until Congress acts, her puzzle is missing a piece.

Each week at the clinic where Bell works, pediatrician Nikki Ivancic says more than 300 children receive care — half through Medicaid and another 15 percent through CHIP. Ivancic blames Congress’ lapsed vote to approve CHIP’s funding because members “got so wound up in repeal and replace bills, this just fell by the wayside.”

With the Senate in recess this week and the House of Representatives out the next, time to find a fix is running out — along with the public’s patience. In a recent poll from the PBS NewsHour and Marist, 78 percent of U.S. adults said they disapproved of the way Congress has handled health care reform.

Ivancic, who is president of the Mississippi chapter of the American Academy of Pediatrics, says her clinic and its patients haven’t yet felt the effects of indecision on Capitol Hill. But she said she doesn’t know what patients will do after March if Congress fails to act. Without coverage through CHIP, Ivancic said she thinks states would be forced to slash dental, mental health and preventative care benefits, which could spiral into bigger, costlier problems as children grow older.

“It’s easier to provide good health in children than to fix medical problems in older people that were preventable in childhood,” Ivancic said.

Earlier this year, Republican Sen. Orrin Hatch of Utah, who established the program with Democratic Sen. Edward Kennedy in 1997, put forward legislation — the KIDS Act of 2017 — to keep the program afloat for another five years, at a cost of $8.2 billion. A summer filled with attempts to dismantle Obamacare drained time and resources from passing other legislation, even CHIP, which has enjoyed bipartisan support for years, said Joan Alker, who directs the Center for Children and Families at Georgetown University. Negotiations over Graham-Cassidy amendments to Obamacare consumed the days before the voting deadline for CHIP’s federal funding, and House Republicans postponed their vote after Democrats disagreed with how to fund the program, The Hill reported.

The Senate Finance Committee released a statement from Hatch on Oct. 4 where he said the KIDS Act “is an important step toward ensuring the children and families who rely on CHIP do not see a lapse in health coverage” and that he was committed to advancing the bill “in a fiscally responsible manner to provide certainty for this critical, bipartisan program.”

Senate leadership have not announced when a vote could happen, but it is not expected in the next week when senators return from recess.

If Congress doesn’t resolve the program’s funding, “we’ll start to see consequences,” Alker said. Utah requested permission to freeze new enrollment, she said, adding that Nevada has warned it may soon send out notices. In July, the Medicaid and CHIP Payment and Access Commission reported that Minnesota, the District of Columbia, Arizona and North Carolina are projected to run out of money by December.

The uncertainty for the program comes at a time when 95 percent of U.S. children have health insurance, the highest in the the nation’s history, the Annie E. Casey Foundation reported in June.

Federal coffers fund 100 percent of Mississippi’s CHIP program, said Therese Hanna of the Center for Mississippi Health Policy, adding that if those dollars are lost, children whose families earn too much money to qualify for Medicaid will hurt the most. Generally, the program’s complex funding formula offers 65 to 85 percent back in federal money for every state dollar spent, so it’s difficult to know when states will run out of money, Alker said. And if this state of limbo persists for a few months, she said the gains the nation has reported in achieving near-universal health care coverage for children will slip away.

“We don’t want kids to be uninsured,” she said. “It exposes families to medical debt and economic insecurity.”

In September, the Congressional Budget Office estimated the program’s total enrollment would shrink to 2 million children by 2027, with Medicaid, individual marketplace-based and employer health insurance absorbing most children currently enrolled.

“CBO anticipates that if lawmakers did not provide additional funding for subsequent years, all state CHIP programs would terminate at some point during fiscal year 2018,” the report warned.

Back at the clinic in Tupelo, Michelle Bell said she hopes lawmakers in Washington preserve the program. Out of the $1,600 she earns each month, along with her husband’s disability check, $750 covers rent for her family’s home. If she had to pay for health insurance premiums without CHIP, Bell said she would be out another $700, leaving little wiggle room for groceries, utilities and gas money. She said she won’t panic — yet: “They may pull it through, but if they don’t, I don’t know where my kids will be.”

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