Clock ticking down on children’s health funding

Differences between the House and Senate ahead could threaten funding for a program that provides health care to some 9 million low- and middle-income children.

Senators last week announced a bipartisan deal to extend the Children’s Health Insurance Program (CHIP), which is set to expire at the end of the month.

Advocacy groups hailed the agreement, but passage of a bill is far from assured. 

Lawmakers have a tight legislative window and little margin for error. 

{mosads}Leaders of the Senate Finance Committee this week said they have agreed to extend CHIP for five years. Text of the legislation has yet to be released, and there has been little discussion about how to pay for the renewal, which is a key sticking point.

Senate aides said the renewal of CHIP would move in its own bill. A markup could happen as early as next week, though that could be delayed if the chamber takes one last shot at ObamaCare repeal.

Meanwhile, the House appears stalled on what to do about CHIP. Aides from both parties said bipartisan discussions are ongoing, but lawmakers left town on Thursday without announcing a deal; they won’t return for over a week.

House Energy and Commerce Committee leaders Greg Walden (R-Ore.) and Frank Pallone Jr. (D-N.J.) are signaling they want a broader legislative package. There are a host of expiring Medicare programs that could be included in a bill, such as funding for community health centers. 

“Bipartisan discussions continue, and I’m hopeful that we can finalize an agreement that includes CHIP, community health centers and other important health care provisions and get it to the floor before the end of the fiscal year,” Pallone said in a statement to The Hill.

But adding additional provisions could create problems in the Senate.

“I think CHIP should stand alone. I’d like to keep it that way,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said.

Walden’s committee had hoped to mark up CHIP legislation this week, but that didn’t happen. Now the chamber risks running out of time to work out a deal.

“It’s a huge concern the House has no bill,” said Bruce Lesley, president of the children’s health advocacy group First Focus. “There’s no way this can ping pong [between the chambers] in the last week.”

Walden said the committee would write its own bill, but unlike the Senate, it won’t make any announcements until it determines how long the reauthorization will be and how it will be paid for.

“That’s not to say we aren’t in regular communication with the Senate. Both houses know we have a tight timeline here,” Walden said.

A two-year CHIP reauthorization passed in April 2015, months before the program was set to expire, and the provision was included in a larger Medicare reform package. 

But lawmakers are bumping up closer to the deadline this year.

If Congress misses the deadline, states wouldn’t run out of money for their programs right away, but they’ll have to start planning to shut them down.

Three states and Washington, D.C., could use up all of their federal CHIP money by December, according to the Medicaid and CHIP Payment and Access Commission. Thirty-one states and D.C. would exhaust their funds by March 2018.

Advocacy groups said it would be much easier if the House just takes up the Senate’s stand-alone proposal.

“There’s always this temptation to view CHIP as a must-pass vehicle, and as an engine to pull things behind it,” said Cynthia Pellegrini, senior vice president of public policy and government affairs at the March of Dimes.

“CHIP always turns out to be a very weak vehicle. Even though people may want to pile things on, experience shows that’s not going to work,” she said.

There’s also the issue of offsets. Every new provision added to the bill raises the cost, and it will have to be paid for.

“A small offset isn’t hard,” Lesley said. “But once other things get added, you start getting into issues. One added offset can pull the whole thing down.”