We all know the feeling of falling into the same dinner routine.
You’ve been making spaghetti every Tuesday night for the past two months. Today, though, you have the best intentions of making a unique, delicious meal. Then, that last meeting runs later than you expected, and by the time you make your long commute and run to the grocery store, it’s late, and it looks like it’s time for another spaghetti dinner.
Congress knows the feeling of a routine, too, but instead of making another spaghetti dinner without a second thought, it’s planning to spend billions of dollars—again—on a health program without addressing its structural problems.
In this case, the Children’s Health Insurance Program is at issue. CHIP was created 20 years ago to address the high number of uninsured low-income children. Though it has given children coverage, CHIP has significant room to improve the range of options available to the program’s young enrollees.
Every few years, Congress re-evaluates the program before it renews funding. But this time, funding expired on Sept. 30. Recently, the House took a floor vote on a bill that, for the most part, simply affirmed the status quo.
Congress spent the summer trying and failing to undo Obamacare’s damage to the individual health insurance market. CHIP was also damaged by Obamacare, and Congress so far has missed the opportunity to fully undo the damage there as well.
For example, Congress could have reversed some of the Obamacare damage to CHIP by eliminating its “Maintenance of Effort” provision, which requires states to maintain whatever upper eligibility limits they had for CHIP in order to receive funds. In New York, this means the state has to provide coverage for children in families of four making up to $99,630, or it loses CHIP funds.
A better approach would be to target federal dollars at those who need it most and give states flexibility to manage their program. The House bill waits three years to give states flexibility to manage their populations.
What’s more, Congress still needs to address the underlying structural problems within CHIP.
An official report of the Government Accountability Office revealed that CHIP children are three times more likely to have difficulty obtaining a referral to a specialist than their privately insured peers. They are also more likely to use the emergency department.
This points to a fundamental access problem within the program—and a problem that is solvable.
CHIP was designed to give states flexibility, in hopes that children would have access to a variety of health care options. But in many states, the result has been that CHIP kids end up at the mercy of their state’s bureaucratic decisions.
For example, a parent may wish to use a health savings account or direct primary care, or get assistance toward their employer-based insurance plan. But under CHIP, that decision is left up to the states, rather than the parents who are closest to the medical needs of the children.
One way to solve this challenge would be to restructure funding within the program so that parents, instead of states, are put in charge of the decision about where their CHIP dollars are spent.
Not only would that give children access to better health care options, it also would help Republicans to move toward their broader goal of undoing the damage of Obamacare and moving toward a freer system for all.