Axing CHIP: Big Pwogs' Conspiracy of Silence

It is frankly disgusting but perhaps not surprising that not one major pwoggie blue blog is even covering this story, the fact the House health bill axes CHIP, the Children's Health Insurance Program. I'm not even talking about giving it major play, the big blogs are fucking disappearing this story. I've just visited Dailykos and TalkingPointsMemo, MYDD (other than mytwo non-front-paged articles (where you can inform yourself further on the issue's complexities)), nothing. Firedoglake, nothing. Found nothing at huffpost's admittedly vast site. Firedoglake's Daily Health Care News – 11/6/09, 11/5/09, nothing. This for a program that was used aggressively in 2007 and 2008 to hammer President Bush for his heartlessness? How soon we 'forget' or change our priorities depending on Democratic Party uber alles?

The only place discussing the House Bill's repeal of CHIP is the Washington Independent, where Mike Lillis has another insightful piece today. It is a reasonably balanced piece, and no one is denying this is a complex issue. But we should discuss the death of CHIP, not silence any discussion. Right? Here's a piece of the article, but you really should read the whole thing:

The $894 billion health reform bill working its way toward a House vote this week would repeal the Children's Health Insurance Program, shifting some low-income kids into Medicaid and others into private plans that would both cost more and guarantee fewer benefits. Which program the youngsters tumble into hinges, not on need, but on the state where they live - a design some advocates call "the lottery of geography."
. . .

"Much of the House bill is good, but on CHIP they only did half a loaf," said Bruce Lesley, president of First Focus, a children's health advocacy group. . . .

The House bill . . . expands Medicaid eligibility to 150 percent of poverty and shifts all kids living above that level to private plans contained on a proposed insurance marketplace, or exchange, the proposal also carves out an exception in states which augmented Medicaid in lieu of creating a separate CHIP program. In those cases, the youngsters would remain in Medicaid.

The distinction carries both coverage and cost implications. Under current law, all state Medicaid programs are required to offer a blanket system of preventative care known as the early periodic screening, diagnosis and treatment program, or EPSDT. The exchange plans, on the other hand, don't have the same mandate. (Although states with stand-alone CHIP programs are not bound to cover EPSDT services, some of them do.) . . .

And because states have vastly different income-eligibility levels for Medicaid and CHIP, the House bill offers no guarantee that the most vulnerable kids would receive the most robust benefits. In New Jersey, for example, Medicaid covers youngsters up to 200 percent of poverty, at which point CHIP takes over and covers kids up to 350 percent. Minnesota, by contrast, covers kids up to 275 percent of poverty under Medicaid but has no stand-alone CHIP plan.

The result? Children living at 275 percent of poverty in Minnesota would, under the House bill, still pay almost nothing for care under Medicaid -- including EPSDT coverage -- while families living at the same income level in New Jersey will be responsible for 22 percent of the cost of their exchange plans, without the assurance of EPSDT services. . . .

. . . there are more New Jerseys out there than Minnesotas. Currently, about 5.3 million (or 72 percent) of the 7.4 million CHIP kids live in states with stand-alone CHIP programs, according to Georgetown University's Center for Children and Families.

Please note that Marian Wright Edelman and the Children's Defense Fund have come out strongly against the death of CHIP (instead supporting an alternative bill that would make it consistently cover every child in families up to 300% of poverty):

"They're going to be paying a lot more out of their pockets and getting fewer benefits," warned Alison Buist, director of child health at the Children's Defense Fund.

CHIP is not being killed out of ignorance about what that will do. The concerns of Edelman have been reflected in the House debate, and rejected:

Some House lawmakers recognize the potential problems. During the markup of health reform legislation in the Education and Labor Committee, for example, lawmakers passed an amendment -- offered by Rep. Bobby Scott (D-Va.) -- requiring that all exchange plans offer EPSDT services. That proposal, however, was stripped out in the final bill.

Another amendment, offered by Rep. Diana DeGette (D-Col.), would have prevented the shift from CHIP to private plans unless the White House provided certification that the private plans offered comparable benefits. That proposal passed the Energy and Commerce Committee, but was also removed in the final bill.

DeGette's office said earlier this week that the certification language was removed "to reflect some budgetary constraints."

Finally, yes, Senator Jay Rockefeller may ride to the rescue. Or, he may not, how do we 'know' he will when real progressives aren't being kept informed, when no one even knows what's going on?

In the Senate, members of the Finance Committee last month passed an amendment to reauthorize CHIP through 2019. The sponsor of that amendment, Sen. Jay Rockefeller (D-W.Va.), is already vowing to fight for that provision all the way to the White House.

"We need to make sure children can keep their CHIP coverage and not be forced into untested private coverage," Rockefeller said in a statement this week. "Health care reform should improve the coverage children have -- not take their coverage away."

As I said yesterday,

The cost of providing CHIP to all families up to 300% of poverty level would be $11 billion a year over ten years. Anyway, like the Washington Independent writer says, "Get out the popcorn. This saga is just getting started." Hey, do more than watch. Contact Senator Rockefeller and tell him you're 100% support his efforts to save CHIP.

Even better contact Nancy Pelosi and tell her axing CHIP sucks, but try to use words that won't 'make' them cover their ears and not listen to the 'concern troll'.

Tags: Big Progressive Blogs, Children's Health Insurance Program, Health care, Marian Wright Edelman, Senator Jay Rockefeller (all tags)

Comments

7 Comments

Re: Axing CHIP: Big Pwogs' Conspiracy of Silence

P.S. -- I'm using the word 'conspiracy' to attract attention to this issue. It may simply be a 'conspiracy' of unawareness about this major, damned important, issue.

by fairleft2 2009-11-06 11:14AM | 0 recs
AXING CHIP: Why it may be no big deal

In reading through the argument against folding CHIP into Medicaid and the Exchange the argument focused on two points. One there is a particular bundle of preventive services for children (EPSDT) mandated by CHIP that is not so mandated by Medicaid. Second an Exchange Family Plan is more expensive than a Children only CHIP coverage.

The latter does not seem like a serious argument, of course adding more people is going to cost more, The question is whether the net cost of actually providing the kids the same level of care goes up. And I would say no. Under the bill not only are preventive care and well-baby and well-child care mandated under any Exchange Plan, insurers are prohibited from imposing any cost-sharing on the family. Thus the charge that eliminating CHIP eliminates EPSDT is not entirely founded. At least I would need some explanation of what it includes that the Exchange Essential Benefits package does not.

Under the bill some children will be moved from CHIP to Medicaid because of  the increase in income eligibility. But the transition language mandates a study to ensure that each state's Medicaid provides coverage to such children "at least" as good as that of their CHIP did.

So while it is an important issue it needs to be discussed in terms of the specific language of the bill in order to determine what exactly "AXING CHIP" means and doesn't mean.

It has been my sad experience through the whole process since the bills came out in July is for critics of the House bill from both left and right to seize on surface provisions of the bill that on close examination either don't exist or have been mitigated elsewhere in the bill. The problem is that once partisans have grabbed on to the propositions of either "this bill is garbage, Kill the Bill! Single Payer now!" or alternately "this bill is a a Government takeover of medicine, Kill the Socialist Bill Now!" reasoned argument based on a close examination of the bill language yields to passionate indignation.

The question I ask progressives before they wax wroth is "Why do you think John Dingell sold you out in this way when he has been pushing for universal coverage since 1954?". And mostly the answer is "He didn't, you just missed the mitigating language in Sec 222 (or wherever)"

The current Medicaid/CHIP complex is kind of a mess with really terrible national variations. I believe that on-net the nation's working poor families are going to come out way ahead, I mean the bill scores to reduce the number of non-elderly uninsured from 81% to 94% (96% if you exclude illegals, but I regard that as a failure in the bill, working families deserve medical care no matter what piece of paper dad and mom have or don't have in their wallets).

Pelosi, Dingell and the Tri-Committee Chairmen delivered the best package they thought they could, and based on their combined records I think that progressives should accept that this was a good faith effort, and not as so many do as some huge sellout.

by Bruce Webb 2009-11-07 07:03AM | 0 recs
Sec 222 (c)(1) No Cost Sharing for Preventive

Services (p.107), is many pages away from Sec 1703 (d)  Repeal of CHIP (p.1034) and the interaction of the two may not be obvious. But before we cry 'conspiracy' maybe we could consider the possibility that Tri-Committee and Speaker's Office staff are fully cognizant of this issue and believe they have mitigated the impacts of Sec 1703 elsewhere in the bill.

by Bruce Webb 2009-11-07 07:17AM | 0 recs
Re: AXING CHIP: Why it may be no big deal

You haven't backed up your subject line title. Of course it is good that kids up to 133% or 150% of poverty level will be put into Medicaid. My point and Rockefeller's concerns the kids between 133%/150% and 300% of poverty level. They need assurances at least that the private plans will have the EPSDT mandated by CHIP, and that if their parents decide they can't afford health insurance (we're talking 'taxing' these 'almost poor' people (in a terrible and insecure economy) 8-12% (or more after 2013) of income, ferchrissake) that at least their kids can still get 'same as CHIP' coverage. The preceding is neither hard to understand nor very expensive to accomplish. In fact Congresspeople were actually trying to 'get there', as I pointed out in the diary, but were voted down.

by fairleft2 2009-11-09 07:16AM | 0 recs
Re: Axing CHIP: Big Pwogs' Conspiracy of Silence

fairleft2, it is great that you are raising this important issue.  Children should not be left worse off in health reform.  There is no need to repeal the Children's Health Insurance Program (CHIP) as part of health reform, as it would clearly leave children will less affordable health coverage.

Bruce Webb, the facts are clear on this point.  When Senator Rockefeller offered an amendment in the Senate to protect CHIP from being repealed, the Congressional Budget Office (CBO) Director Doug Elmendorf wrote:

"...the committee voted to continue the Children's Health Insurance Program (CHIP) as a stand-alone insurance program. CBO expects that offering continuity of coverage for several million children in CHIP would keep some children insured who would not have been covered under the Chairman's mark; under the mark as it was originally offered, which would have eliminated CHIP, CBO anticipated that some of those children would be eligible for subsidized coverage in the exchanges but would not be enrolled in an exchange plan (owing at least in part to the higher premiums and higher out-of-pocket costs that they would typically face in such a plan)."

In short, keeping CHIP results in a lower uninsured rate for kids and more affordable coverage.  Children do not have PAC funding like insurance companies, which explains that the push to move children from CHIP into the exchange was admitted by a Democratic aide in an Inside CMS story reported on by Mike Lillis's Washington Independent story to feed the coffers of insurance companies.

Health reform must happen and we need it now.  But, let's make sure children are not harmed.

CDF President Marian Wright Edelman has a column on this issue expressing the need to fix the legislation for legislation (see http://blackstarnews.com/news/125/ARTICL E/6094/2009-11-06.html).

by mcadoo11 2009-11-07 09:45AM | 0 recs
Rockefellers amendment to the Senate

Bill does not necessarily imply that there is a similar weakness in the House version. People are confusing apples and oranges here. Using actual language in HR3962 where is my analysis wrong? I am not much impressed by appeals to authority that only relate to a different piece of legislation.

by Bruce Webb 2009-11-07 03:43PM | 0 recs
Re: Rockefellers amendment to the Senate

The House bill repeals CHIP.  Out-of-pocket costs for a family would exceed 10% of income.  CHIP provides very limited out-of-pocket costs.  Simple math: kids would be worse off.

by mcadoo11 2009-11-07 05:30PM | 0 recs

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