Tax cuts? Hell. No. Thousands of American Indian and Alaska Native children will lose health insurance

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Mark Trahant / Trahant Reports

Congress has yet to reenact the Children’s Health Insurance Program and states will soon run out of funds to prop up the program. That will mean that thousands of American Indian and Alaska Native children will lose their health insurance. And, the result is the Indian Health Service will have to stretch its already thin dollars to try and cover the budget hole.

The Children’s Health Insurance Program expired Sept. 30. This federal program insures young people and pregnant women who make just enough money not to qualify for Medicaid (but can’t afford private insurance). The idea is to make sure that every child has the resources to see a doctor when they are ill.

It’s hard to break down precise numbers because agencies lump funds from the Children’s Health Insurance Program or CHIP into Medicaid data. But we do know that the law worked really well. We also know there are more than 216,000 children that have health insurance because of Medicaid and the CHIP. Indeed, Native American children rely on Medicaid and CHIP at much higher percentages than other population groups. A study by Georgetown reported that 54 percent of American Indian and Alaska Native children were enrolled in Medicaid or CHIP as compared to 39 percent of all children. “Even though much progress has been made in extending Medicaid coverage to American Indians and Alaska Natives, the uninsured rate for American Indian and Alaska Native children and families remain unacceptably high,” the report said.

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Source: Georgetown University Health Policy Institute. Coverage Trends for American Indian and Alaska Native Children and Families.

Overall the uninsured rate among non-elderly American Indians and Alaska Natives fell by 7 percentage points from 24 percent to 17 percent, according to the Kaiser Family Foundation.

This is a big deal and here’s why: The Indian Health Service is a health care delivery operation that works best when insurance (third-party billing in government-speak) pays for the medical costs. Medicaid, CHIP, Medicare, and other third-party billing now accounts for 22 percent of the IHS’ $6.15 billion budget.

But if Children’s health is no longer funded (because Congress did not reauthorize the legislation) then the Indian Health Service will have to make up the difference. That means taking money away from other patients and programs. It will be a critical problem for clinics because by law dollars from third-party billing (or Medicaid and CHIP) remain local.

Alaska is the state most impacted by Congress’ failure to act because two-thirds of the children in the Native health system are covered by Medicaid or CHIP. Other states where there will be significant hits: Montana, North Dakota, South Dakota, Washington, New Mexico, Oklahoma, North Carolina, and California.

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Source: Georgetown University Health Policy Institute

The House of Representatives passed a CHIP reauthorization in early November. But that bill included a $6.35 billion budget cut to other health programs, including the Prevention and Public Health Fund, which provides money for vaccines, smoking cessation, and other initiatives to improve public health. The House would also ban lottery winners from being insured by Medicaid, tighten the timetable for people to sign up, and to change other rules.

It’s unlikely the Senate will agree. But the Senate is not moving quickly to pass its own legislation. The Senate is too busy working out tax cuts that will benefit large corporations and the very wealthy. (Previous post: What matters? Tax fight is about seven competing values.)

Across the country, some nine million low- and middle-income children rely on CHIP for health coverage. And, according to The Hill newspaper, States have asked the Centers for Medicare and Medicaid Services for funding to hold them over in the interim, and the agency has awarded about $607 million in redistributed funds to states and U.S. territories. Tribes will also lose hundreds of thousands of dollars in CHIP-related grants.

Last month, Utah Republican Orrin Hatch, who chairs the Senate committee responsible, called CHIP a “top priority” that had bipartisan support. The committee passed the bill October 2. But it’s up to Majority Leader Mitch McConnell, R-Kentucky, to bring the legislation to the floor for enactment. Then the House and Senate would have to iron out and agree on their differences before the bill can become law.

Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports

Reposting or reprinting this column? Please do so. Just credit: Mark Trahant / TrahantReports.com #IndigenousNewsWire #NativeVote18

Children’s health insurance should be an easy vote, but not so in this Congress

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More than half of all American Indian and Alaska Native children are insured by Medicaid and the Children’s Health Insurance Program (IHS.gov photo)

Mark Trahant /Trahant Reports

Here we go again: Congress is finding new ways to complicate health care.

It really boils down to the philosophy that government-funded health care is just another word for welfare. So it’s a good thing to cut it back and limit it. The other side of that is that funding health care is a right and smart because a healthy population is more productive and better for everyone. There is a third element, of course, for Indian Country, and that’s the notion that health care delivery represents a solemn promise made through treaties; thus a pre-paid obligation.

Over the past few months I’ve written a lot about the role of Medicaid in the Indian Health system, a revenue stream that raises about $880 billion. Medicaid is a federal-state partnership, so even though the federal government ultimately pays the bill for American Indians and Alaska Natives, the rules and regulations go through the states. And if that’s not complicated enough, there’s an “and” added to Medicaid … the Children’s Health Insurance Program or CHIP. On budget lines these two programs are lumped together, Medicaid and CHIP. Mostly because the funds are administered by state Medicaid programs.

The idea of CHIP is simple. The richest country in the world ought to make sure that children have health insurance and are able to see doctors (it was added to a budget resolution in 1997). “In general, CHIP reaches children whose families have incomes too high to qualify for Medicaid but too low to afford private health insurance,” the government says.

The key here is that American Indian and Alaska Children rely on Medicaid and CHIP at higher levels than the general population. In 2015 54 percent of Native children were enrolled in Medicaid or CHIP compared to 39 percent of children nationally (which is still a big number).

Congress works on two tracks. One track is language to authorize spending and an additional track is when Congress appropriates the money. The problem here comes from track one: The authorization for CHIP expired October 1 and it must be renewed before new funding.

This was supposed to be easy. A letter to Congress from the National Governors Association was clear:  “CHIP is widely supported by governors, who recognize that access to health insurance is critical to ensuring a healthy start for our nation’s children. Since CHIP was enacted, the uninsured rate for children age 18 or younger has fallen from 14.9% to 4.8% … Governors urge you to protect children’s coverage and give states certainty by providing an extension of funding for the program.”

Not only do governors from both parties agree that CHIP worked but so do a vast majority of Americans, one Kaiser Family Foundation polls pegged support at 75 percent.

In the Senate leaders have been saying, repeatedly, not to worry. CHIP renewal will happen. A bipartisan bill was in the works and put on hold while the Senate debated its larger Graham-Cassidy healthcare measure. (There were all sorts of provisions in that bill to muck up CHIP.)

But we are past that, right? Now Congress should just pass a clean extension of CHIP and, for good measure, make a few fixes to the Affordable Care Act, and then argue about other things. That was the Senate proposal.

However in the House: “Unlike the Senate KIDS Act, the House HEALTHY KIDS Act also includes offset policies designed to appropriately reduce federal spending so the extension of CHIP funding does not increase the deficit.”

In other words: The House wants to cut other programs first.

The House bill will add money to the Puerto Rico Medicaid program. But, as the Center for Budget and Policy Priorities point out it’s not enough. “The HEALTHY KIDS Act includes up to $1 billion in additional funding for Puerto Rico’s Medicaid program to help the Commonwealth recover from the devastation of Hurricane Maria.  While this is a welcome move, it falls well short of what Puerto Rico needs, and the bill provides no assistance to the U.S. Virgin Islands, badly damaged by Hurricanes Irma and Maria.” Then the House bill cuts public health funding by $5 billion and shortens the grace period for people trying to pay Affordable Care Act premiums. Two kick-the-rich provisions: Allowing states to disenroll lottery winners (because we all could win, right?) and charging higher Medicare premiums to wealthy seniors.

The House committee is urging its members to vote fast. “States are currently using unspent FY2017 CHIP allotments and redistributed funds from the Centers for Medicare and Medicaid Services (CMS) to cover current spending needs for their CHIP programs,” the committee told its members. “Without Congressional action, states could start to exhaust these funds as early as November.”

Ten states could run out of money by next month, including Arizona, Utah and especially, Minnesota. According to Kaiser Health News, “Minnesota was among those most imperiled because it had spent all its funds … Emily Piper, commissioner of the Minnesota Department of Human Services, reported in a newspaper commentary last month that her state’s funds would be exhausted last Sunday.”

If a state does not reimburse the Indian health system for these costs, IHS, as the payer of last resort, could be on the hook for these additional costs.

 

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Source: Kaiser Family Foundation

The numbers are significant. A study by Georgetown University Health Policy Institute said the uninsured rate for AI/AN children declined from 25% to 15% between 2008 to 2015. All of the states with very high proportions of their AI/AN children on Medicaid saw very large double-digit declines. The two states with the largest declines in their uninsured rate for kids were New Mexico (38% to 11%) and Alaska (32% to 17%).

“At a time when Congress is considering extremely large cuts to Medicaid and a dangerous restructuring of the program, AI/AN families are especially at risk,” the study concluded.

The politics ahead are difficult. The House bill adds budget cuts as a way to reach 218 votes. This works by making it more conservative. But it also removes the bipartisan approach, something that’s worked so well since CHIP was created. And even the House’s conservative tilt might not generate enough support for the measure to pass.

This is all nonsense. We know CHIP works. It’s government at its best. (If we do anything … we should expand it and add more children.) So the law’s renewal should be a quick “yes” vote. Then, what’s next? But Congress has to complicate — make that muck up — a program that works.

 

Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports

Reposting or reprinting this column? Please do so. Just credit: Mark Trahant / TrahantReports.com #IndigenousNewsWire #NativeVote18

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