Even as debate over the future of the Affordable Care Act extended into September and ultimately reached what may prove to be a temporary lull, researchers at George Washington University’s Milken Institute School of Public Health have focused on two critical programs reaching medically underserved and vulnerable populations: the Children’s Health Insurance Program (CHIP) and federally funded community health centers. Financial support for both ended on Sept. 30, but the Senate will consider a five-year funding extension this week.
This focus has resulted in blogs and issue briefs on CHIP by Professor Sara Rosenbaum (who also writes frequently on the ACA for Health Affairs, the Commonwealth Fund, and the Milbank Quarterly) and colleagues Rachel Gunsalus, Sara Schmucker, and former GW senior research associate Sara Rothenberg. This focus also has produced a report on what’s at risk for health centers, co-authored by Professor Rosenbaum, Professor Peter Shin, and research colleagues Jessica Sharac and Rachel Gunsalus. (Rosenbaum detailed her concerns about the failed Graham-Cassidy bill in two recent Health Affairs blogs. Her first blog provides important insights into the bill’s Medicaid provisions; her second blog, which focuses on a revised version of the bill, includes the observation that the revised version would, like its predecessor, would fundamentally alter the federal/state relationship in Medicaid.)
“In a nation that considers employer-sponsored coverage the central form of health insurance for working-age Americans and their families, it is striking that 1 in 2 children depends on public health insurance,” Rosenbaum wrote in an op-ed piece for Millbank Quarterly. In the piece, citing Kaiser Family Foundation statistics, she explained that Medicaid and CHIP insure 36 million children, who represent 51% of all people enrolled in Medicaid and CHIP.
In a Health Affairs blog, Rosenbaum made observations about the Senate’s KIDS Act, which would extend funding for CHIP through Fiscal Year 2022 and is awaiting congressional action. (On October 4, the Senate Finance Committee will consider the Act, cosponsored by the Committee’s chair and ranking minority member, Senator Orrin Hatch (R- UT) and Ron Wyden (D-OR). In her blog, Rosenbaum noted that “CHIP has been widely credited with helping reduce the percentage of U.S. children without health insurance, from nearly 14 percent in 1997 to fewer than 5 percent by 2015.” She stressed that the children assisted by CHIP are the lowest-income children in the U.S.; nearly all states target CHIP to children with family incomes twice poverty or lower. The CHIP program enjoys bipartisan support, partly because of its design and flexibility, Rosenbaum pointed out in an issue brief for the Commonwealth Fund.
Part of the School’s Geiger Gibson/RCHN Community Health Foundation Research Collaborative, the health centers report has drawn attention to what could happen if Congress fails to renew federal health center funding. If the Health Center Fund (established as part of the ACA) is not continued, community health centers could lose 70 percent of their federal grant funding in Fiscal Year 2018. As a result nearly 9 million people could lose access to health care, and associated site closures could eliminate 51,000 health care jobs, leading to an economic downturn in communities located throughout the U.S.
“I am deeply concerned about the Congress’ failure to renew community health center funding and the widespread impacts its loss will have throughout our country if Congress does not act soon,” Rosenbaum said. (The House of Representatives' Energy and Commerce committee is doing a full committee markup on several bills tomorrow, one of which includes the funding for community health centers.)
Rosenbaum stresses that funding for both CHIP and community health centers is crucially important to ensure the health of our nation’s citizens. As she concluded in her op-ed piece for Millbank Quarterly: “Like their parents, American children may have many separate pathways to health insurance but they all depend on the same health care system. What Congress does to health programs for low-income children ultimately will affect the overall stability of the health care system for all children. This is a fundamental truth our nation must remember as it wallows in the fog of politics and ideology.”