House, Senate Committees Pass CHIP Bill Proposals
By Virgil Dickson Modern Healthcare October 4, 2017
Senate and House panels on Wednesday passed their own bills Wednesday that would reauthorize federal funding to maintain low-cost health insurance to 8.9 million children and 370,000 pregnant women.
While the Senate Finance Committee quickly passed its Keeping Kids' Insurance Dependable and Secure (KIDS) Act, which has bipartisan support extends federal funding for the Children's Health Insurance Program for five years, the House Energy and Commerce Committee spent hours debating how to pay for the reauthorization.
After six hours of debate, the House committee passed its CHIP bill in a 28-23 vote along party lines.
During the House panel's markup hearing Wednesday, Democrat members slammed a Republican proposal to partially pay for CHIP by charging higher Medicare premiums to seniors earning more than $500,000. The Senate version of the bill does not suggest an offset to fund the program.
"Here we are with a partisan bill that asks for coverage of children on the backs of seniors," said Rep. Diana DeGette (D-Colo.).
The suggestion could derail CHIP altogether, warned Rep. Anna Eshoo (D-Calif.), who noted that other bills circling in Congress, including proposed tax cuts, don't suggest how they will be funded.
But some Republicans maintained that higher Medicare premiums for wealthy beneficiaries likely wouldn't be a hardship.
"If they don't want to pay, they don't have to enroll into Medicare," Rep. Fred Upton (R-Mich.) said.
It's unclear whether Democrats could derail the House bill in that chamber. Even if it does pass, Senate Republicans could balk at the pay for proposals.
The Senate's bill changes CHIP too. It eliminates an Affordable Care Act provision that enhanced federal allotments for the program by 23%, with states receiving matching levels ranging from 88% to 100%. The matching funds would continue through fiscal year 2019, fall to 11.5% in fiscal year 2020 and be eliminated entirely in fiscal year 2021.
Unlike their House counterparts, the House Finance Committee members agreed not to propose any amendments to their bill in an effort to move it to the Senate floor quickly. Several senators plan to introduce amendments later.
Without reauthorization, providers are worried millions of children will lose access to care. States are already talking about freezing or ending coverage if the federal funds stop flowing.
"It is paramount that we act quickly both here in committee and through the next steps in the process to ensure eligible children do not go uninsured once federal funding is exhausted," Committee Chairman Sen. Orrin Hatch (R-Utah).
The Senate will be taking a week-long recess starting Oct. 9. Congress last funded CHIP through the Medicare Access and CHIP Reauthorization Act of 2015. It provided nearly $40 billion in federal funding to states over the last two fiscal years and ended Sept. 30.
Sen. Pat Toomey (R-Pa.) was the sole no vote on moving the bill out of committee. He wanted to include a provision that would prevent members of Congress from appropriating CHIP funds for other items not related to the program.
Toomey pointed to a Congressional Research Service finding that $42 billion in unspent, CHIP-allocated funds had been redirected to unrelated programs via the appropriations process since 2009.
The most recent continuing resolution drew $2.65 billion from excess CHIP funding to spend on unrelated programs.
That will only get worse with the KIDS act, Toomey said. The reauthorization bill would allocate between $21 billion to $25 billion annually through fiscal 2022. There is no evidence that CHIP costs run over $15 billion total every year.
Toomey's amendment would have altered how states receive CHIP payments to ensure they wouldn't get more funding than they need and create extra funds for Congress to reappropriate.
Hatch, a co-sponsor of the original CHIP legislation in 1997, urged Toomey to propose his amendment on the Senate floor.
"I never thought [CHIP] would be used a slush fund and am very disappointed," Hatch said.
Sen. Debbie Stabenow (D-Mich.) also failed to add an amendment to the bill. Her proposal would have continued federal funding for community health centers.
Under the ACA and later MACRA, more than 1,200 facilities nationwide receive $3.6 billion in annual funding. That's roughly 70% of the federal funding available to them. The funding ended Sept. 30.
Health centers now serve 27 million people, or 1 in 12 Americans. HHS estimates that as many as 2,800 health center locations could close their doors without continued federal cash. That could jeopardize 9 million patients' access to care.
"We would see real devastation for families throughout the country," Stabenow said.