Federal funding for the Children's Health Insurance Program (CHIP), which provides health coverage for almost nine million children, ran out on Saturday night. Everyone in Congress knew the deadline was approaching. By all accounts, an overwhelming bipartisan majority of lawmakers even wanted to renew it. Yet it didn't happen.
The whole mess is a microcosm for the malignant incompetence of the Republican-led government.
Created under President Clinton in 1997, CHIP was designed to provide decent medical coverage to children whose families make too little to purchase it on their own, but also too much to qualify for Medicaid. It covers everything from dental and eye care to immunizations to emergency visits and more. Under CHIP, routine doctor visits are free, and while there can be cost-sharing for other medical services, no one has to pay more than 5 percent of their annual family income. The program knocked the uninsurance rate for children down from 14 percent at its inception to 4.5 percent by 2015. Today, CHIP covers 8.9 million children — the vast majority from families who make twice the poverty level at most — and another 370,000 pregnant women.
Like Medicaid, CHIP runs off a combination of federal and state funding, with the former contributing around $14 billion per year. Unfortunately, the federal contribution is not open-ended: It has to be renewed every few years. The last renewal was in 2015, for two years. It ran out on Sept. 30.
The states have a little bit of a cushion. They don't burn through the federal money all at once, and leftover funds can be rolled over into the following year's funding. But the situation is tight. One projection shows Washington, D.C., Arizona, Minnesota, and North Carolina running through their remaining federal funds by the end of 2017. The worst-case scenario is that much bigger states like California also bleed dry by the end of the year. By June 2018, every state except Wyoming is expected to exhaust their federal money as well. (Wyoming will join them by September.) The inevitable results will be state budget chaos, confusion among enrollees, people denied enrollment, cuts to payments for care, and more.
How did this happen? The answer, put simply, is the Republican Congress' obsession with killing ObamaCare.
Part of the problem was that ObamaCare actually increased CHIP's federal contribution by 23 percent. So the generally bipartisan support for CHIP was complicated by the GOP's unyielding belief that everything associated with ObamaCare is unacceptable and must go. Yet even then, Sens. Orrin Hatch (R-Utah) and Ron Wyden (D-Ore.) were able to hammer out an agreement that would've extended CHIP funding for five years while slowly winding down the ObamaCare increase. What happened next was that Republicans decided to take one last shot at killing ObamaCare with the Cassidy-Graham health-care bill just as CHIP's funding deadline loomed, and the Senate simply didn't have the attention for anything else.
"Momentum was building," Bruce Lesley, the president of First Focus, a children’s advocacy group in Washington, told the Los Angeles Times. But once the Cassidy-Graham brouhaha started, "we couldn’t even get a meeting," Lesley said. "No one was even taking our calls."
In fact, CHIP wasn't the only health-care funding that quietly died during that fight. The federal government's Community Health Center Fund provides around $3.6 billion annually around the country. That's 70 percent of all the federal money that goes to community health centers, and about 20 percent of the total annual funding they receive. Without that money, observers are anticipating that 2,800 health-care facilities across America will close, killing 50,000 jobs for care providers and other staff. The fund was renewed in 2015 for two years, and also expired on Saturday.
"Twenty-five million Americans use these centers each year, nearly three-quarters of them below the poverty line," David Dayen explained in The New Republic. "An estimated nine million would be left with no medical home if funding expires."
Now that the Republicans' fourth effort to kill ObamaCare has died with an ignominious whimper, lawmakers are suddenly hearing the public outcry over the expired funding. Hatch and Wyden's compromise is still alive in the Senate, and Axios reported the Senate Finance Committee will mark the bill up on Wednesday. Sens. Debbie Stabenow (D-Mich.) and Roy Blunt (R-Mo.) have also introduced legislation to extend community health center funding another five years. And the Energy and Commerce Committee is scheduled to mark up legislation on both questions this week as well.
So it's possible Congress could still get its act together in relatively short order.
But the fact that we even reached this point speaks volumes. It wasn't as if Congress was tripped up by an actual crisis. Puerto Rico is certainly dealing with monumental devastation from Hurricane Maria. But that wasn't what the Senate was debating. Nor can the oversight be laid purely at the feet of President Trump, blinkered as he is.
All four attempts to kill ObamaCare have been utterly vapid exercises, marred by policy illiteracy, and driven solely by seven years of Republican ideological fever and empty promises to "repeal and replace" the Democrats' health-care law — never mind the catastrophic consequences for millions of Americans. Funding for CHIP and community health centers were both far more straightforward matters of extending existing programs — and for far less money that what was at stake in the various TrumpCare bills. Yet it was in the name of pursuing their ridiculous quest, even after three successive failures, that Republican congressional leadership allowed those critical programs to run aground.
Of course, in a better world federal funding for CHIP and the Community Health Center Fund would never be designed to expire in the first place. But in the world we live in, Congress and the president should renew these programs in a timely manner. Competent and humane governance requires at least that much.