California Frets Over Funding After Congress Misses Health Care Deadlines

More than a million California children get their health insurance from the Children's Health Insurance Program, also know as "CHIP."  Like they do with Medicaid, states split the costs for CHIP with the federal government. But Congress missed an Oct. 1 deadline to renew CHIP funding -- a lapse that many blame on the drawn-out effort to repeal the Affordable Care Act. That fight put other health care priorities on the back burner, and anxiety is growing about when -- or if -- Congress will reauthorize the money to pay for them.

What exactly is CHIP?

CHIP is a little-known program but very important. Everyone knows about Medi-Cal, which  covers lots of low-income children (and many adults as well), but CHIP is for children whose parents make too much money to qualify them for Medi-Cal, but don't have insurance through their jobs.

"It saddens me because, I mean, they're children. Children should not be politicized," said Dr. Porshia Mack, chief medical officer at the Tiburcio Vasquez Health Center in Hayward.

A lot of people agree with Mack. CHIP has never been a controversial program, unlike the Affordable Care Act. It's always had bipartisan support since its start in 1997. Everyone professes a desire to insure children, and kids are relatively cheap to insure, compared to adults and seniors.

So what happened?

Congress simply missed the deadline to renew the funding. In September, the Senate decided to try yet again to repeal and replace the Affordable Care Act, and it was so busy that CHIP was one of many programs that just didn't get voted on in time.

This week, Congress is  starting to discuss reauthorizing the money for CHIP, but some of the ideas include ratcheting down the funding amounts. In recent years, CHIP funding had gotten a financial boost from the Affordable Care Act. Right now, California's share of CHIP's costs amount to $364 million a year, but some of the new funding proposals being floated in Congress would increase California's CHIP contribution to $1.5 billion a year.

California's CHIP program does have enough money to keep going through the end of 2017, according to the state's Medicaid director, Mari Cantwell. If the federal funding does not come back by January, the state could face some difficult decisions. Cantwell said most children won't actually be kicked off of their insurance, but California would have to pay much more to move them into Medi-Cal plans to keep them insured.

What else has been put on the back burner while Congress debated the Affordable Care Act?

There were a number of health programs that also had funding deadlines of Sept. 30. One program provides federal funding for community health clinics like Tiburcio Vasquez in Hayward. These are safety-net clinics that typically treat low-income people on Medi-Cal, and also provide a last resort for uninsured or undocumented people who have no other options. In California, the federal funding for these clinics came to $1.6 billion over the past five years.  Clinic directors in California have been vocal about the importance of this money over the past few weeks, and are especially anxious now that the deadline has been missed. They're saying Congress really has to act soon.

What about the future of Obamacare itself? It seems to be very unclear about which direction it's heading.

The repeal efforts seem to have stopped for now, or at least for 2017.  But there was also a separate bill to fix one of the chief problems plaguing Obamacare, and that has also been delayed. The bill would have stabilized the individual insurance markets in the states by locking in funding that the Trump administration has threatened to cut. As a result of the ongoing uncertainty, some insurance companies have dropped out of the markets, and some have raised premiums for 2018.

Some states are waiting to see if that bill gets passed, and there is movement this week to revive it. But others have already announced that the premiums are going to increase. In Georgia, for example, premiums are set to go up by 50 percent for 2018 -- all because Congress hasn't yet fixed this funding gap.  California still hasn't released the rates for Covered California plans for 2018, but they will have to do that soon, because open enrollment for 2018 starts on Nov. 1.