Doctor examining child
Sasha Suzi

While members of Congress are preoccupied with tax reform, millions of American children, including thousands of kids in Montana, are at urgent risk of losing their health care coverage due to congressional inaction.

Congress will be in session for only two more weeks this month before recessing for the rest of the year. They must not fail to renew funding for the federal Children’s Health Insurance Program before they leave Washington, D.C.

It is unacceptable that CHIP was allowed to expire at the end of September, but at least most states had set aside enough funding to extend coverage for a few more months. Now that money is running out – and time is running out for the nearly 9 million children in the United States who are covered by CHIP.

In Montana, nearly 24,000 children count on CHIP to help their families pay for their health care. If Congress fails to act within the next couple of weeks, the families of these children will be sent letters from the Montana Department of Public Health and Human Services informing them that the program will have no funding left after January.

The federal government provides the bulk of funding for CHIP, with states contributing about 15 percent of the total cost and parents whose children are covered by CHIP paying an average of $150 per child per year, according to estimates by the nonpartisan Medicaid and CHIP Payment and Access Commission.

In Montana, CHIP is part of the larger Healthy Montana Kids program, which also includes Children’s Medicaid. Those with incomes up to $261 percent of the federal poverty level ($64,206 a year for a two-parent, two-child family) may qualify for CHIP, and those with incomes up to 143 percent of the federal poverty level ($35,178 for a two-parent, two-child family) may qualify for coverage under Medicaid expansion.

All told, more than 123,000 children in Montana – one out of every three children in the state – is covered through Healthy Montana Kids. According to the Montana Budget and Policy Center, the program covers 71 percent of children living in or near poverty, half of all children with disabilities or other special health care needs, and all of the children in state foster care (there were more than 3,000 at last count).

Thanks in large part to the Healthy Montana Kids program, 92 percent of children in Montana have health insurance, and therefore, access to health care. The Montana Budget and Policy Center has compiled research that shows this coverage:

  • leads to better health in adulthood – including lower blood pressure, fewer hospitalizations, and even fewer deaths in adulthood;
  • improves the likelihood of high school graduation and college attendance;
  • reduces bankruptcies, thereby improving families’ financial stability, and 
  • benefits Montana schools, which receive $55 million in Medicaid funds – $36 million of which is federal – and use this funding to hire school health care staff as well as pay for health supplies that benefit all children.

Not surprisingly, the popular, proven effective 20-year-old federal Children’s Health Insurance Program has strong bipartisan support. The problem is that Republicans and Democrats in Congress are deeply divided over how best to fund it.

Consider that a bill to reauthorize CHIP for another five years passed the U.S. House last month. However, 174 members of the U.S. House, nearly all Democrats, voted against it over concerns about the way the legislation proposed to fund the program. The bill, which passed with 242 votes, including 15 votes from Democrats, proposes to pay for CHIP by raiding the prevention and public health fund established by the Patient Protection and Affordable Care Act.

The majority of House Democrats saw this as yet another GOP attempt to erode Obamacare. The prevention fund bolsters a number of critical services that allow states to expand support for those with Alzheimer’s, diabetes and other chronic disease, as well as immunization program and dozens of other initiatives that help lower health care costs upfront. Further, the prevention fund, which allocated less than $1 billion in the most recent fiscal year, does not have nearly enough money to pay the full federal portion of CHIP costs, which topped $13.4 billion in fiscal year 2016.

Now the Senate will have to decide whether to go along with the House’s funding solution or some up with one of its own. The clock is ticking, with 11 states predicting they will run out of CHIP funding by the end of the year, according to a Kaiser Family Foundation survey. Montana is among the 21 additional states, including the District of Columbia, that expect to be tapped out by March 2018 or sooner.

If the Senate does not reauthorize the program soon, Montana will still be on the hook to maintain coverage for nearly 7,000 children under Medicaid expansion requirements outlined in the Affordable Care Act. Given Montana’s tenuous budget situation, scraping together enough money to pay yet another major unforeseen bill may even require a second special legislative session.

And that still won’t help the nearly 24,000 Montana kids who will lose CHIP coverage.

In order to pass in the Senate, the House bill needs 60 votes – meaning eight Democrats will have to join all Republicans in supporting the bill. All three of Montana’s congressional delegates, like the majority of their peers in Congress, support reauthorizing CHIP funding.

Sen. Jon Tester, D-Montana, is also cosponsoring other legislation, introduced in September, to keep the Children's Health Insurance Program funded for the next five years. Including Tester, the bill is cosponsored by 17 Democrats and five Republicans; U.S. Sen. Steve Daines, R-Montana, is not one of them.

Lacking any clear path to bridging the political gap that appears to divide them, some senators are weighing the feasibility of adding CHIP reauthorization to the government funding bill that comes with a Dec. 8 deadline. They should certainly pursue this idea, and Montana’s senators should push to make it happen.

CHIP should have been reauthorized well before it expired in September. Congress should not drag its feet any longer. Montana’s kids are depending on them.

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