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Top of Our "To Do" List: Reauthorize CHIP!

First On Our “Must Do” List for Congress: Reauthorize CHIP!
For the first time since they left Washington, D.C., for the holidays, both chambers of Congress are back this week with a full slate of must-pass legislation left over from last year.
Top of the “must-do” list for us is a long-term reauthorization of the Children’s Health Insurance Program (CHIP), which expired in September. CHIP funds health insurance for nine million kids, including two million children with serious chronic conditions. Without guaranteed long-term federal support, states are spending down reserves and moving to cut off new enrollments as a first step to shutting down their CHIP programs altogether.
In December, Republicans chose to prioritize passing deficit-busting tax cuts for billionaires over reauthorizing health care for kids. Instead, Congress passed a short-term funding patch that was intended to keep the program afloat through the end of March. But, the Centers for Medicare & Medicaid Services (CMS) has warned that some states will run out of money by January 19.
While there is strong bipartisan support for CHIP, the parties have split over how to pay for the program, with Republicans insisting on deep cuts to other critical health programs to offset CHIP’s costs. In a plot twist this week, the prospects of a deal became stronger when the price tag for a 5-year reauthorization of CHIP fell from $8 billion to under $1 billion. 
Why the change? By repealing the Affordable Care Act’s individual mandate, the Republican-passed tax bill is projected to drive up ACA premiums in 2019, because fewer healthy people will buy coverage. The result will be that ACA coverage will be more expensive for the government to subsidize than it would otherwise have been. If CHIP were to lapse, budget scorekeepers predict that some of the children currently insured through CHIP would move to the now-more-expensive ACA plans. If CHIP were to be reauthorized, however, the government’s “new” spending on CHIP would only be $800 million over current law.
It’s an only-in-Washington solution: Republicans made their CHIP spending problem magically disappear by raising the government’s other costs. In fact, a 10-year reauthorization of CHIP--  instead of 5-year deal -- would now save the government $6 billion, leading Democrats to call for a longer-term or even permanent renewal. With funding for the overall government also set to expire on January 19, there is a chance that CHIP could be added to another short-term funding bill—if Congress feels pressure to act.
At the same time, Congress is struggling to come together on a host of other must-pass deals with big implications for women, people of color, immigrants and the LGBTQ community.
Following a televised negotiation at the White House in which Donald Trump both agreed to and rejected passing a clean DACA deal to help Dreamers brought to the U.S. as children, it’s unclear what will happen next. Anti-immigrant Republicans in Congress and the administration are pushing a wasteful $18 billion border wall as their price for restoring basic employment and health care rights to the Dreamers. A  court decision this week temporarily reinstating DACA nationwide, while positive, could take the pressure off of Republican moderates to find a legislative fix.
Meanwhile, the two parties still haven’t reached a deal to waive “sequestration” (the automatic spending cuts mandated by the 2011 Budget Control Act) for Fiscal Years 2018 and 2019, even though we’re four months into FY18. If these cuts were to take effect, both defense and non-defense funding would be slashed, including a host of health-related programs ranging family planning through Title X to HIV/AIDS medical care through the Ryan White program.
The other big news this week was an announcement by the Trump administration that states will now be allowed to include work requirements in their Medicaid expansion proposals. The Obama administration had long resisted approving work requirements, arguing that they violate long-standing Medicaid law. Under the law, state proposals must “assist in promoting the objectives of [Medicaid]” to expand medical care to the needy. At best, work requirements do nothing to expand access to care and at worst, lead to denials of care, with major consequences for women and people of color.
In our 2016 report on state Medicaid proposals, we noted that 60 percent of the then-nearly 3 million adults in the Medicaid coverage gap were already working. Among those not working, the vast majority are students, care-takers, those too ill to work and those already actively looking for work.
From a public health perspective, it makes little sense to deny coverage that helps prevent the spread of disease, allows the mentally ill to access care, and ensures that family members are able to care for individuals who might otherwise require more costly services like nursing homes.
The consequences for women and people of color would be particularly severe.While women and men have had roughly equivalent unemployment rates post-recession, women are far more likely to work part-time, making them vulnerable to the kinds of hourly requirements legislators have proposed. In 2014, for example, women accounted for 66 percent of the part-time work force and only 41 percent of the full-time workforce. Likewise, since the 1940s, the unemployment rate among African Americans has been consistently double that of white Americans.


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