Children’s Health-Care Myths
By now perhaps you’ve heard that Republicans in Congress are denying health care to poor children, because what else would those robber barons do? The debate over funding the children’s health-insurance program could benefit from a fact or two, not least about political cynicism.
The program known as CHIP was passed in the 1990s to offer health insurance to children in low- and middle-income families that earn too much to qualify for Medicaid. CHIP expired Sept. 30, but states have had unspent money in the interim, and Congress freed up for more in last month’s budget deal. None of the some nine million beneficiaries have lost insurance, and the program enjoys bipartisan support. This has not stopped press stories about children who will be denied care.
The hold up for long-term funding has been finding ways to pay for the program’s extension, and Democrats claim that the GOP put a tax bill for the wealthy ahead of children’s health care. Irony alert: House Republicans suggested paying for part of the program with slightly higher premiums for affluent Medicare beneficiaries. Democrats refused.
Irony two: Last week the Congressional Budget Office reduced the cost of a five-year extension to $800 million over 10 years from more than $8 billion. Here’s why: Republicans as part of tax reform zeroed out the ObamaCare penalty for declining to buy health insurance.
CBO says that repealing the individual mandate will make coverage on the ObamaCare exchanges more expensive, and without CHIP more children and families would end up on the exchanges. By this logic the government “saves” money by spending on CHIP instead of the alternative. In other words, the Republican tax bill made it easier to pass a bill for children’s health care, though the GOP can expect no political credit.
This magic math continued this week with a CBO projection leaked to Politico that if Congress reauthorized the program for a full decade, the government would save $6 billion. No doubt the purpose is to make CHIP look like a deal for the government, which actually spent more than $14 billion on the program in 2017. If Republicans extend the program for 100 years, will they save $60 billion?
The GOP will reauthorize CHIP with de minimis changes, but there are reasons to reform this entitlement on the merits, even if Republicans don’t have the capital to do so in a midterm year. One problem is that CHIP crowds out private insurance. States can also set eligibility requirements that reach up to 405% of the poverty level, which means fewer resources for the truly needy. The program started as a partnership but in 2016 states pitched in less than $2 billion of the $15.6 billion total, according to the Heritage Foundation.
Someone should track down Henry Waxman, the former Democratic Congressman who during the Affordable Care Act debates of 2009 told Kaiser Health News that “once health care reform is in place, however, the case for a separate program for children” that excludes parents is “less compelling.” The exchanges will offer “solid coverage” that is affordable for parents and kids, Mr. Waxman said. Democrats never have to answer for these failures because the press prefers to pump stories about Republican meanness.
The only CHIP question in Washington is whether to extend it as part of a new budget deal or by itself, and Democrats appear to be holding up the process by demanding a deal on immigration first. That Republicans don’t care if poor children lose medical care is one more falsehood you can dismiss this week.
Appeared in the January 11, 2018, print edition.