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Granite State Rumblings: Protecting Children’s Healthcare Programs Both State and Federal

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The Children’s Health Insurance Program, CHIP, is often hailed as a model of a successful children’s health care program. It covers 8 million children who are not eligible for Medicaid and whose families cannot afford private insurance. In fact, research has found that since the program’s launch in 1997, the uninsured rate among U.S. children has fallen by half, from 14 percent in 1997 to 7 percent in 2012. ~ Source: The American Public Health Association

From its inception CHIP has enjoyed a large measure of bipartisan support. After all, who wouldn’t support insuring kids? As part of the Affordable Care Act, CHIP was authorized through 2019, though its funding was only extended through 2015. While federal legislation has been introduced in both the House and Senate that would extend CHIP funding for an additional four years, given the state of national politics, its reauthorization this year has advocates and state governors worried.

Like Medicaid, the Children’s Health Insurance Program is funded jointly by the states and the federal government. Unlike Medicaid, CHIP insures children from families with higher income levels and comes with a significantly better federal matching rate. On average, the federal government pays 57 percent of the costs for Medicaid but 70 percent of the costs for CHIP.

How each state would be affected if CHIP is not renewed varies, since each state runs its program differently. Some states keep their CHIP programs wholly separate from Medicaid; other states have simply expanded Medicaid to encompass CHIP; still others operate a combination of the two depending on income levels.

The eight states that cover all CHIP recipients through Medicaid would see their federal assistance drop to Medicaid levels, costing them about $1 billion collectively, according to Georgetown University’s Health Policy Institute. Those states, which are politically diverse and include California, Maryland, South Carolina and New Hampshire, would be required to continue covering CHIP recipients because they’re a part of Medicaid, which is an unlimited entitlement program, not a limited block grant like CHIP.

The 14 states that operate totally separate programs, however, wouldn’t even have the benefit of funding reduced to Medicaid levels. Those states would have to pay the entire cost of the program, which would mean upwards of $5 billion. Since their programs are separate, these states are also not under obligation to continue covering CHIP recipients. For the remaining states, the budget implications vary wildly.

With federal funding for the Children’s Health Insurance Program set to expire in September, children’s health advocates are calling on policymakers to take action on behalf of the millions of children at risk of losing access to affordable and comprehensive care. ~ Sources: Governing the States and Localities, Georgetown University Health Policy Institute, First Focus.

GROWING UP GRANITE

The House Finance Committee has scheduled three public hearings on HB1 and HB2. These hearings provide an important opportunity for all Granite Staters to express the priorities, programs and services that they believe the state should be addressing and funding. Please turn out and offer your testimony to the members of the House Finance Committee. Taking two to three minutes to share your personal stories about the programs and services that support you and your family, that keep your children safe and healthy, that protect your aging parents, and help keep your community strong and vital are critical to help ensure that all Granite Staters have the same opportunities.

The first meeting will be held in Concord this Thursday, March 5th in Rep’s Hall from 4-7 p.m.

The second and third meetings will be held concurrently in Conway and Derry on Monday, March 9, from 5-8 p.m.

  • The Conway hearing will be held in the Kennet High School Auditorium, 409 Eagles Way, North Conway.
  • The Derry meeting will be held at Derry Town Hall, 14 Manning Street, Derry.

If you are unable to attend one of the hearings, then please consider sending your story to the committee via e-mail at: HouseFinanceCommittee@leg.state.nh.us

Here’s an editorial from the Concord Monitor that shows very clearly why your voice is needed at one of the Finance Committee hearings. New Hampshire cannot afford to leave federal funds on the table.

Editorial: Hold placed on federal grants is shortsighted
Sunday, March 1, 2015

Last week, the directors and staff of one agency after another, in a semblance of Edvard Munch’s famous painting The Scream, cupped their faces in their hands and moaned, “Oh no, we’re Kurked.” And if the fiscally conservative chairman of the Joint Legislative Fiscal Committee gets his way, thousands of low-income adults only recently insured under the state’s expanded Medicaid program will follow suit.

For the first time in memory, under Neal Kurk’s leadership, the fiscal committee placed a hold on millions of dollars in hard-won federal grants. The decision will delay some awards, and depending on the committee’s decision, potentially result in a decision not to accept some federal largesse. The number of holds is unprecedented and shortsighted.

State agencies and employees, hoping to meet needs they fear won’t get funded any other way, put a lot of effort into writing grants and securing outside funding. If they succeed only to learn that the committee, or down the line the Executive Council, declines to accept the money, willingness to go the extra mile to find outside money will wane. New Hampshire, which at about 71 cents on the dollar already gets back less of its federal tax payments in federal spending than almost every other state, will become even more the donor state.

Kurk believes the decision to accept federal funds should be made not grant by grant but in the context of the state’s budget process. But New Hampshire is one of a minority of states that still uses a biennial budget. That could lead to inordinate delays in decision-making and the provision of the services the grants were meant to meet.

What Republicans who agree with Kurk really fear is a stampede of agency-accepted Trojan horses, gifts that could commit the state to additional spending. As Senate President Chuck Morse told Monitor State House reporter Allie Morris, taking free money to buy a fire truck is one thing, but who will pay to staff it, fuel it and insure it?

Meanwhile, for want of a fire truck, the barn is lost.

The committee is holding up money that would pay to collect information on violent deaths in the state and, at a time when opioid drug use and overdose deaths are epidemic, an investigator for the state’s drug task force. Other grants on hold were awarded to promote child safety, improve mental health services and help schools develop emergency plans.

Whatever the ultimate fate of the grants, the committee’s hold on them will do less harm than a goal its Republican members hope to achieve: a refusal by the majority party to reauthorize the state’s decision to expand Medicaid to serve low-income adults who aren’t disabled, even though the federal government will pick up 90 percent of the tab.

That decision would cancel coverage for more than 20,000 newly insured residents and make it far harder for them to get non-emergency and preventive health care. That, in our view, is misguided to the point of being immoral. Virtually every other advanced nation considers access to health care a right, not a societal luxury.

The Republican goal, if met, will also mean the loss of more than $300 million per year in federal funds, assuming even more of those eligible sign up under expanded Medicaid. That’s money that won’t be providing health care for low-income New Hampshire residents and good-paying jobs for the people who provide their care.

Looking a gift horse in the mouth and saying “No” is one thing. Hay, after all, can get expensive.

But it’s quite another if that “No” means plowing less land and going hungry or freezing to death on the long walk to the doctor’s office.

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About MaryLou Beaver

New Hampshire Campaign Director Every Child Matters Education Fund
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