"I don’t think there’s any reason to dismantle a program that works."
– Senator Jay Rockefeller, on the Children’s Health Insurance Program (CHIP).

Though Jay Rockefeller saved CHIP in the Senate Finance committee version of health insurance reform, the House version has gotten rid of it. As pointed out in the Charleston Gazette, moving children into the insurance exchanges (those with parents who can afford to do that, you’d be out of luck if your parents can’t afford health insurance) means these kids’ health care gets much more costly and covers much less:

If the children were moved to private insurance, their parents would also pay significantly more in premiums and out-of-pocket expense, according to an actuarial study by financial consulting firm Watson Wyatt Worldwide.

Using data from 17 states, researchers found that, at 175 to 225 percent of poverty, parents of CHIP children paid up to 2 percent of their child’s treatment. If the same children were transferred to private plans, their parents would pay between 5 and 35 percent of the cost of care.

"Most of these parents are working people who are counting dollars," said Renate Pore, health care analyst for the West Virginia Center on Budget and Policy. Families eligible for CHIP make too much to be eligible for Medicaid, but not enough to afford private insurance, she said.

"CHIP is the stronger coverage package, and we are very concerned about the idea that those kids would be moved over without some protection," said Bruce Lesley, director of First Focus, the national child advocacy group that commissioned the actuarial study.

The CHIP program includes developmental screening and preventative care that is not covered by most adult plans. It covers a wide range of services, including doctor and hospital visits, immunizations and prescriptions, tests and X-rays, diabetic care, and dental and vision care. It provides case management for children with special needs.

"There are many wonderful parts of the reform legislation, and many things in health care that need to be changed," Lesley said, "but this is one that should be left alone."

Note the anonymity of the critic in the next passage. Inside the Beltway it is apparently politically dangerous to advocate for good health care for children:

Yet the proposed shuffle has roused concerns from some Democratic lawmakers and children’s health care advocates, who fear the move would cause some youngsters to lose coverage as they jump from highly subsidized CHIP plans into private coverage that could prove more expensive for those low-income families. Critics also worry that the private plans won’t offer the same extensive benefits that CHIP does.

"The president has promised to build upon what works and to allow people to keep the coverage they have," said a representative of one children’s welfare group, speaking only anonymously because of the delicate political nature of the topic. "That promise should apply to kids as well. However, there is growing concern and evidence that the health insurance exchanges will still impose higher out-of-pocket costs for families with fewer benefits for children than CHIP coverage."

As noted in Rabble.ca,

Suzy Khimm at TAPPED argues that killing CHIP could be a good thing, provided the kids continue to enjoy the same legal protections that they get under the public plan. Khimm suggests that moving low-risk kids into insurance exchanges could help keep costs down for everyone by making the risk pool healthier on average. . . .

That’s a nice idea, but it seems foolish to scrap a popular and successful social program in favor of an untested insurance exchange system.

Rockefeller is much more doubtful than Khimm about putting kids at the mercy of the insurance companies in the exchanges, and actually echoes Rabble’s sentiments (emphasis added):

Under the finance panel’s bill [prior to its revision], Medicaid would be expanded, but the CHIP program would phase out as those kids transitioned into insurance plans on newly proposed state insurance exchanges. Rockefeller argued the need to keep those youngsters in CHIP, rather than pushing them to the exchange, “where they’re at the mercy of people who will have them for lunch.” He was talking about private insurance companies.

The West Virginia Democrat, who chairs the Finance Committee’s health subpanel, sponsored an amendment to keep CHIP as it is. “I don’t think there’s any reason to dismantle a program that works,” he said.

BTW, CHIP can be much improved, for example by legislating that it cover all kids in families up to 400% of the federal poverty level. Marian Wright Edelman:

We need to end the bureaucratic barriers that keep two out of three of the more than eight million uninsured children who are already eligible for either CHIP or Medicaid from actually getting the care they need. A simple, seamless enrollment process like older Americans have for Medicare would ensure our children are cared for and covered. We need to guarantee every child access to the full range of preventive and other health care services they need and that we now provide to all children in Medicaid but not to all children in CHIP or in the proposed Exchange. A child covered by CHIP has the same value as a child covered by Medicaid and all deserve comprehensive care regardless of the program they are in. And we need to provide an affordable national health safety net for children whose families make up to 300 percent of the Federal Poverty Level ($66,000 for a family of four) and eliminate the unjust lottery of geography. Whether a child’s family can afford coverage should not depend on where they live. New York covers children up to 400 percent; North Dakota only to 160 percent; and Massachusetts and twenty-one other states, plus the District of Columbia are already at 300 percent. A child in North Dakota is no less valuable than a child in New York or Massachusetts.