Health Care for Low-Income Americans Still in Limbo

States are hoping Congress can make space on the year-end agenda to fund the Children’s Health Insurance Program and community health centers.

Senate Finance Committee Chairman Orrin Hatch
AP Photo/Manuel Balce Ceneta
Nov. 27, 2017, 8 p.m.

Nearly two months after funding for the Children’s Health Insurance Program and community health centers expired, states and advocates are watching Congress closely to see whether those programs can compete with Republicans’ other top agenda items during the coming end-of-year bargaining sessions.

Multiple states are getting down to the wire as they are burning through leftover funds to keep CHIP—which provides coverage for kids whose parents make too much to qualify for Medicaid—running in their states.

Colorado’s Department of Health Care Policy and Financing on Monday began sending letters out to members of the state’s CHIP program advising them to start looking at private options. Other states are poised to do the same in December.

“States are already wasting money preparing contingency plans,” said Joan Alker, executive director of the Center for Children and Families. She added that states may hold off from starting the process to shut down their programs if they receive signals from Congress that there will be movement to extend resources.

“Virginia … currently anticipates sending families letters in early December if Congress does not act soon to fund CHIP,” Linda Nablo, chief deputy director for the Virginia Department of Medical Assistance Services, wrote in an email. “It may not be exactly on December 1st if it appears Congress is likely to act close to that date—but we need to give families sufficient notice that their child’s coverage may end on January 31st when Virginia will have to close it without federal funds.”

Nablo added that as the state gets closer to the beginning of December, it will asses the likelihood of congressional action almost daily and make a decision when the state can no longer wait to notify families.

Congress, however, already has a lot on its plate. Senate Republicans are aiming to get their tax reform through the chamber—a measure that includes a repeal of the Obamacare individual mandate, the least popular part of the health care law.

One potential vehicle CHIP could hitch a ride on would be the end-of-year government-funding bill, which Congress has to pass by Dec. 8. But there are details that lawmakers still need to reconcile.

Both the House and the Senate versions of the legislation would extend the program for five years. However, the House version contained controversial pay-fors while the Senate has yet to unveil bipartisan ways to fund the program.

“I am working with my colleagues to advance this bill in a fiscally responsible manner so we can ensure coverage is maintained,” Senate Finance Chairman Orrin Hatch said in a statement.

Arizona, which expects to run out of funds in December, may end up dipping into an existing Medicaid program for low-income kids to cover expenses for its CHIP program. And Utah will have to decide to notify families about its program coverage in December if there is no congressional action.

“I think the states again are trying to do the right thing as much as possible. So they have drafted the notices; they are trying not to send those out, but it’s coming to the point it’s hard for them to hold off any longer,” said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

States’ CHIP programs are not the only ones feeling the squeeze. Extended funding for community health centers was wrapped into the House CHIP bill, which has not seen further action since it was passed out of the chamber earlier this month. The Senate has not moved on any legislation, but Sens. Roy Blunt and Debbie Stabenow introduced a measure at the end of September to reauthorize the Community Health Center Fund for five years.

Congress’ failure to dedicate money to these centers has already caused disruptions. A survey by the National Association of Community Health Centers in early October found that 72 percent of health centers plan to institute a hiring freeze, 41 percent will lay off staff, and 47 percent will reduce staff hours.

According to the NACHC, health centers serve more than 27 million patients, including 1.2 million homeless patients and more than 300,000 veterans.

The group cites estimates from the Health and Human Services Department showing that failure to extend resources for the centers would cause 9 million low-income Americans to lose health care access, 2,800 locations to close, and 51,000 jobs to be eliminated.

“The problem has been all along the ticking clock and other legislative issues that have been big distractions,” said Amy Simmons Farber, communications director at the NACHC.

Not providing more funds could also affect other key health care initiatives. “Keep in mind, also, that a lot of health centers have programs in place for opioid addiction, to fight that battle. Those are some of the programs that you may see impacted,” Farber said.

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