Jay Rockefeller has so far saved the Children’s Health Insurance Program from being swallowed up by the mysterious but probably pretty crappy health care to be forced on poor families in the new health care system’s ‘health insurance exchanges’. He has got Reid’s bill to preserve CHIP till 2019! Not that it was just Rocky. Good on yah to Marian Wright Edelman too, and the Children’s Defense Fund, who are fighting for CHIP and children too. And Cynthia Tucker:

. . . the [new health insurance] exchanges might easily be more expensive. Yes, many families would be eligible for subsidies; but there is no guarantee the policies for their children would be as affordable, or as comprehensive, as they are under the CHIP programs.

Or say thank you to Rev. Ray Hammond, founder of the Boston Ten Point Coalition:

We wanna guarantee every child access to all of the health services that they need and I don’t care whether they’ve got Medicaid or they’ve got CHIP or they’ve got private insurance or they’ve got the insurance that our elected representatives get. . . . Last thing we want — tell your neighbor, ‘Get rid of the jigsaw puzzle!’ You go from one state to the next, and in one state a child is covered and in the next state the child is not covered. That’s not right!

And thanks to the New England Alliance for Children’s Health and their action alert:

During the mark up process, the Senate Finance Committee approved an amendment from Senator Jay Rockefeller (D – WV) that preserves the CHIP program in its current form and maintains existing Medicaid and CHIP coverage for children through at least 2019. This amendment was substantively revised from its original version. To view the language of the revised Rockefeller amendment, please click here.

The Rockefeller amendment would require states to maintain income eligibility levels for children currently enrolled in Medicaid and CHIP and would allow states to expand these eligibility levels at any time. The CHIP benefit package and cost-sharing rules would continue as under current law, with states beginning to receive a higher CHIP match rate in 2014. . . .

ACTION STEP

Please contact your senators and ask them to reach out to Senate Majority Leader Harry Reid (D – NV) and urge him to include the Rockefeller CHIP amendment and the EPSDT provisions from the original Chairman’s mark in the final Senate bill.

Stan Dorn at the Urban Institute also stepped up:

Stan Dorn, senior health policy researcher at the Urban Institute, said there are certain advantages to scrapping CHIP. Both Medicaid and exchange plans, for example, would never require congressionalreauthorization — a process CHIP is subjected to every few years, he pointed out. But due to CHIP’s affordability, Dorn said “it’s clear” that kids “are much better off” under CHIP than they would be under private exchange plans.

“It’s not even a close question,” Dorn said during a children’s health care forum on Capitol Hill Friday.

Studies suggest Dorn’s concerns are valid. One analysis, conducted by Watson Wyatt Worldwide, an actuarial research firm, found that families living between 175 and 225 percent of the federal poverty level pay just 2 percent or less of treatment costs under CHIP. Under the proposed exchange plans, researchers found, those same families would pay up to 35 percent of their children’s health costs.

And thanks also to First Focus, the national children’s advocacy group, and its director Bruce Lesley, who adds to the above:

"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."

And a big shout out to Mike Lillis at the Washington Independent, for covering the issue when too many pwoggies seem all too willing to sweep children under the rug in the interest of ‘getting _something_ passed’.

As I said in an earlier diary, CHIP is not being killed (it’s still dead in the House bill) out of ignorance about what its destruction will do. In fact, the concerns of Marian Wright Edelman and others have been reflected and rejected in the House debate, as Mike Lillis notes:

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, as I think I said somewhere along the way, what matters is the guarantee of no cost increases and coverage as good as that provided by CHIP. Saving CHIP is what accomplishes that right now, but there are also other ways of achieving those goals.

Anyway, the fight ain’t over; let’s keep our eyes on children’s needs.

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 my two 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’.

"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.