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The fight over health coverage for children, pregnant women

A child has her ear inspected by a doctor using an otoscope. (Photo: Andrew_Popov)

Health insurance coverage for 1.3 million California children and pregnant women is at risk because of Congress’ delay in extending the Children’s Health Insurance Program.

While the House recently approved a bill to extend the program for five years, the bill still needs approval by the Senate and a fight is expected about how to pay for the extension.

The remaining 2 percent – about 26,000 people – would be in danger of being dropped because their incomes are too high for that program.

CHIP serves low-income families. The 20-year-old program expired Sept. 30 and California may run out of funding by the end of the year or early January. The state receives $2.7 billion in funding a year for CHIP.

“The impact is major,” said Anthony Wright, executive director of Health Access California, an advocacy organization. “You can’t lose that much money without their being an impact.”

According to the state Department of Health Care Services, 98 percent of those covered under CHIP would keep their health insurance through 2019 under Medicaid even if the extension isn’t granted. But the remaining 2 percent – about 26,000 people – would be in danger of being dropped because their incomes are too high for that program.

“If CHIP is not reauthorized, the governor and the Legislature would need to deliberate on how to address the population no longer eligible for federal funding,” said Anthony Cava, a department spokesman in an email.

CHIP benefits working families who aren’t able to get health insurance through their jobs.

California’s senators Dianne Feinstein and Kamala Harris have been outspoken in their support for CHIP and have called for the program to be reauthorized quickly.  They pointed out that the program has helped reduce the uninsured rate among American children to 4.5 percent from 13.9 percent in 1997 when the program was enacted.

Feinstein and Harris criticized the delay in a letter last month to the Senate leadership. “Our working families deserve better than this,” the letter said.

In California, CHIP funds used to be administered through a program called Healthy Families. But in 2013, the program was eliminated and those enrolled in it were transferred to Medi-Cal, California’s name for the federal Medicaid program.

Sixty-one percent of CHIP enrollees in California are Hispanic, with 15 percent identified as Caucasian, 11 percent as Asian, 3 percent as African-American and 10 percent as other. Overall, about 13 percent of California’s children are covered by CHIP.

Republicans have faced opposition from Democrats for wanting to pay for CHIP by cutting funds for public health prevention programs created by the Affordable Care Act

Cary Sanders, director of policy analysis for the California Pan-Ethnic Health Network, said CHIP benefits working families who aren’t able to get health insurance through their jobs. It helps families get their kids in for needed doctor visits and ensures that they get vaccinations. “It’s a really important investment in future generations,” she said.

Families enrolled in CHIP don’t have to pay any co-pays or deductibles, said Jen Flory, a policy advocate at the Western Center on Law and Poverty. “It ensures kids get to the doctor at the first sign of something,” she said.

CHIP has long had widespread support from both Democrats and Republicans and advocates, but it was tabled this year during unsuccessful fights by the Republicans to overturn the Affordable Care Act.

The main issue of contention is how to pay for the continuation of the program. Republicans have faced opposition from Democrats for wanting to pay for CHIP by cutting funds for public health prevention programs created by the Affordable Care Act. “They have agreement on the policy but on on the pay fors,” said Michael Odeh, health policy director for Children Now, an advocacy organization.

Wright said he is hopeful that Congress will eventually extend CHIP but is concerned that it is taking this long.

“We don’t want to unnecessarily scare children and families about health coverage so vital to themselves and their economic vitality but the longer this goes on, the more it will force the choice of somebody losing care or coverage,” Wright said.


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