By Cody Belzley
If it ain’t broke, why mess with it? This may be simple reasoning, but sometimes simple makes sense.
A national analysis released this week confirms what we’ve long known: the Children’s Health Insurance Program (CHIP) offers affordable, high-quality coverage for America’s kids. The study also emphasizes that CHIP coverage continues to be relevant and necessary even in the context of health reform. But unless Congress acts quickly, this success story could end next year and millions of children in the U.S. could lose this lifeline.
The report, which was commissioned by the Robert Wood Johnson Foundation and conducted by the nationally recognized actuarial firm the Wakely Consulting Group, finds CHIP offers more comprehensive coverage at lower costs for children than qualified health plans sold through the exchange marketplaces.
The report compares costs and coverage between CHIP plans and qualified health plans in 35 states, including Colorado. The comparison finds that a family of four with an annual income of $50,085 (210 percent of the federal poverty level for a family that size) has average annual out-of-pocket expenses of $161 through Colorado’s version of CHIP, the Child Health Plan Plus (CHP+) program. That same family would face out-of-pocket costs of $960 a year with average marketplace plans.
The analysis also compared child-specific services covered by CHP+ against coverage for the same services in marketplace plans. It found that while benefits are generally comparable, there can be significant differences in coverage and limits for specialty care. In one example, while both CHP+ and marketplace plans cover speech therapy, CHP+ has no restrictions for children under age 3 for access to speech therapy, while marketplace plans restrict the number of therapeutic visits a child may have each year to 20 per type of therapy.
CHIP has been an astounding success. In the wake of a recession that cost millions of parents their jobs and their health insurance, the uninsured rate among America’s children has dropped, thanks in part to CHIP. The same is true in Colorado, where child poverty has increased, but the number of uninsured children has plummeted from 14 percent in 2004-2006 to 8 percent in 2010-2012. And after Colorado’s recent efforts under health reform, we will likely see the actual percent of uninsured children today is even lower when new census numbers come in.
CHIP is a public-private partnership program created to provide affordable, quality health care to children in families that earn too much to qualify for Medicaid, but who can’t afford private coverage. This report shows that even with new coverage options available through exchange marketplaces, CHIP still plays an important role in the health care coverage continuum.
But this success story is at risk because federal funding for CHIP (and, in turn, CHP+) will expire next year unless Congress acts. And recently Congress has made a habit of not acting until the last minute — or not at all. But the last minute won’t work in this case because CHIP is a federal-state partnership and states need time to plan and pass their budgets. If Congress waits, state governments will be forced to make tough decisions about limiting access to or even ending their CHIP programs.
If CHIP ends, some kids may qualify for Medicaid. And others may find coverage through the marketplace. But as the Wakely study shows, marketplace coverage means more cost to families and less care for kids. What is most troubling is to think that many children will likely lose coverage altogether, reversing decades of progress made to ensure every child has every chance to grow up healthy and strong.
But that will only happen if our representatives in Washington fail to act. Now is the time to call on our members of Congress to do what is right for kids and continue investing in CHIP.
Cody Belzley is the vice president of health and strategic initiatives at the Colorado Children’s Campaign and mom to a 4-year-old and 2-year-old.
Opinions expressed in Health News Colorado represent the views of the individual authors.