Today, 9 million families are hoping for Congress to renew the Children’s Health Insurance Program (CHIP), which provides access to health care and broad benefits designed for children, affecting more than 342,000 kids in Pennsylvania.
Despite the divisive political climate and the recent failure of the Graham-Cassidy bill to repeal and replace the Affordable Care Act, CHIP could be one piece of legislation to unite the interests of Congress. For two decades CHIP has been crafted and implemented with bipartisan support. CHIP provides vital health services for children 0-18 in families that may make too much money to be eligible for Medicaid and too little to afford health care through an exchange. Combined with premium and cost sharing protections, access to Medicaid and CHIP keeps coverage and care affordable for low-income families.
The federally funded program is matched by state funds from all 50 states. Pennsylvania is one of the 10 states expected to run out of funding for CHIP in December. Although individual states have increased flexibility to design benefits in separate CHIP programs, most offer more comprehensive benefits at a much lower cost to families than private coverage.
One thing is certain, the CHIP program works to improve access to medical and dental care (often excluded from private health insurance), early childhood screening and vital therapies for children with special needs.
From 1997, when CHIP was enacted, to 2016, the uninsured rate for children has fallen by more than half, from 14 percent to 5 percent. Access to health care from a pediatric provider helps families to comply with the recommendations of the American Association of Pediatrics of seven preventative appointments during the first year of life. As many new parents know, children are often seen many more times during for coughs, colds, rashes and bumps during that same time period. Each of these appointments offers an opportunity for continuous health surveillance during the most crucial and rapid period of child development, and is an ideal time for teaching.
Loss of access to these regular pediatric primary care visits denies children access to Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Evidence has shown that regular medical, vision, hearing, and dental screenings as well as the services necessary to “correct or ameliorate” physical or mental health conditions in childhood allow for intervention early and often to provide the best opportunity for children to succeed at school and in life.
When children are under diagnosed and untreated they are more likely to experience health problems related to cognitive, behavioral, or physical disabilities, and to develop future conditions such as high blood pressure, heart disease, and diabetes. Healthy children have the opportunity to grow up to be healthy adults especially when they miss less school, graduate and enter the workforce.
CHIP provides health care to children with special health care needs (CHSCN). Approximately 14.6 million children ages 0–17 years in the United States have special health care needs that put them at risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally and that may impact their daily functioning. About 65 percent of CSHCN experience more complex service needs that go beyond a primary need for prescription medications to manage their health condition. All CHIP programs cover physical, occupational, and speech and language therapies, often without limits.
Kaiser Family Fund recommends that Congress extend CHIP funding for five years, through 2022, keeping the maintenance of effort requirement and 23-percentage point increase in the CHIP federal match rate through 2022. These modest efforts would ensure that low- and moderate-income children retain access to affordable and comprehensive insurance coverage, maintaining the gain in coverage secured over the past 20 years.
Certainly, children need more than health insurance in order to grow into healthy adults. CHIP is one way to ensure that the most vulnerable children have access to the services they need to give them the best chance at achieving their healthiest potential in life.
Sunny G. Hallowell, PhD, PPCNP-BC, IBCLC, is an assistant professor at Villanova University’s College of Nursing.