An important question has been raised about the Medicare and CHIP (Children's Health Insurance Program, partially funded and administered by states) under the Senate and House proposals for health reform. CHIP is set to expire in 2013. According to the CBO, there are 10 million children and pregnant women on CHIP.
The Senate proposal we have only via rumor and sketchy news report. The House, at least, is a bit clearer. From an issues brief by the invaluable Kaiser Family Foundation:
• What happens to the Children’s Health Insurance Program (CHIP)?
The Children’s Health Insurance Program, which covers uninsured, low-income children with incomes above Medicaid levels, was reauthorized through 2013. The America’s Affordable Health Choices Act would require CHIP enrollees to obtain coverage through the exchange in 2013 or year one of enactment; however, CHIP enrollees with incomes between 100% and 133% of poverty would be transitioned to Medicaid instead of the exchange. There is a CHIP MOE similar to the Medicaid MOE that would remain in place until CHIP enrollees are transitioned into the exchange. This transition would take place in year one (2013) or when the Health Choices Commissioner determines that the Exchange has the capacity to support participation of CHIP enrollees and that there are procedures in place to ensure that the transition would not interrupt coverage. Children transitioned from CHIP to the exchange could face higher cost-sharing and could lose access to certain benefits such as EPSDT (Early Periodic Screening Diagnostic and Treatment Services) especially if they were in a Medicaid-expansion CHIP program.
Note that, as per the child advocacy group Connect For Kids, between CHIP and Medicaid we are talking about a third of the nation's children:
• Do No Harm to Children. Health reform should not turn back the clock on the progress our nation has achieved for children's health coverage. One-third of our nation's children receive their health care through Medicaid and CHIP. Before moving children out of these successful programs, Congress should ensure that children will receive comparable or better benefits, cost-sharing protections, and access to care under any new and untested program. Congress must ensure that children do not lose the benefits and cost-sharing protections they already have under Medicaid and CHIP. If we fail to protect children, we will spend $1 trillion over ten years but leave roughly 10 million children worse off.
• Preserve Medicaid. Medicaid offers a broad benefits package which includes Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services, an expansive definition of "medical necessity" that promotes children’s healthy development, interpretation and translation services, and targeted case management. By providing these services, as well as other guarantee and accountability provisions, Medicaid and CHIP go beyond commercial plans in meeting the unique needs of low-income children and children with special health needs.
HR 3200, the America’s Affordable Health Choices Act 2009 (the House Tri-Committee Bill) would move kids from SCHIP to exchanges/public option or Medicaid. Even then, the loss of early screening and intervention services needs to be guarded against.
The Senate bill, which doesn't exist yet, where there is rumored to be no public option? That requires a few answers.