Congress' Short-term Funding Bill Extends CHIP for 6 Years

Alicia Ault

January 23, 2018

A 3-day government shutdown ended with congressional Democrats and Republicans voting to approve a short-term bill that will fund federal operations through February 8 and will fully fund the Children's Health Insurance Program (CHIP) through fiscal year 2023 (FY23).

President Trump quickly signed the continuing resolution (CR). The Senate and House votes came after a bipartisan group of senators struck a last-minute compromise that would bring a bill to the Senate floor to address the status of certain immigrants — largely children who are losing protection under the Deferred Action on Childhood Arrivals (DACA) law. But it also sets up another showdown over spending priorities in just a few weeks.

The CR also extends through FY23 funding for the Child Enrollment Contingency Fund, the Childhood Obesity Demonstration Project, and the Pediatric Quality Measures Program. States have been receiving an enhanced Federal Matching Assistance Percentage for CHIP, but it will be halved in FY20.

Physician groups — which had been calling for a more stable foundation for CHIP — expressed relief that the program had finally gotten out from under the ongoing drama surrounding the federal government's appropriations.

"Today's action was an important step forward for children and families," said Colleen Kraft, MD, president of the American Academy of Pediatrics, in a statement.

"Extension of the CHIP program will provide access to mental health care services for low-income children and youth who otherwise might not have access to care," said Saul Levin, MD, MPA, CEO and medical director of the American Psychiatric Association, in a statement. CHIP provides health insurance to nearly 9 million children and adolescents and access to mental health care for the estimated 850,000 CHIP beneficiaries experiencing serious behavioral or emotional disorders, said Dr Levin.

Jack Ende, MD, MACP, president of the American College of Physicians (ACP), said that CHIP has helped to reduce the number of uninsured children by 68%. "CHIP has a proven track record of providing high quality, cost-effective coverage for low-income children and pregnant women in working families," said Dr Ende in a statement.

Two members of Congress who helped shepherd a CHIP extension through the House — Energy and Commerce Committee Chairman Greg Walden (R-OR), and Health Subcommittee Chairman Michael C. Burgess, MD (R-TX) — said they were gratified. "Today is a win for the millions of kids and their families that rely on CHIP and its vital services," they said, in a statement. "After a completely unnecessary and avoidable shutdown, families across the country can breathe a sigh of relief knowing they will continue having access to affordable, quality health insurance."

Tax Delays

The CR also includes a delay of several taxes that had been imposed by the Affordable Care Act: a medical device tax; the tax on so-called "Cadillac" health insurance plans; and some other health insurance taxes.

The short-term bill means that many health programs are still left with uncertainty over what will happen on February 8 — the next time the government will run out of money. And it did not reauthorize several expired programs, including the National Health Service Corps, the Teaching Health Center Graduate Medical Education program, and Community Health Centers.

"Now that Congress has acted on CHIP, we urge a similar bipartisan approach to the other pressing child health issues that remain unresolved, such as the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV), which serves at-risk pregnant women and parents with young children," said Dr Kraft of the AAP.

Community Health Centers — which provide primary care to 27 million Americans, regardless of ability to pay — are largely funding by the federal Community Health Center Fund, which ran out of money at the end of September 2017.

Those programs "provide much needed resources for vulnerable and underserved communities across the country," said Dr Ende.

Physician organizations have also urged a permanent solution for the children who were protected under DACA. Trump ordered DACA's demise in September 2017. He said the government would begin phasing it out and that DACA would be fully terminated in March 2018. The law allows children to get jobs, enroll in college, or get a driver's license but not become legal US citizens. Even so, it has been controversial. Some 700,000 children are currently protected by the law.

As part of the compromise to get short-term government funding, Senate Majority Leader Mitch McConnell (KY) said he would allow a bill to replace DACA to come to the Senate floor for a vote before February 8. Not everyone trusts that promise.

"Although there appears to be an understanding that the Senate will vote on bills to protect Dreamers and offer them permanent legal residency, including citizenship, that is far from a guarantee," said Dr Ende. "Many medical students and residents are DACA recipients, and enacting legislation that will allow them to remain in school, residency training, or practice will only benefit patients and our entire healthcare system," he said.

"We also call on lawmakers to find a permanent solution that will allow Dreamers — immigrants brought to the United States as children and who are now young adults — to remain in the United States," said Dr Kraft.

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