By Christian M. Wade CNHI State Reporter
BOSTON – A health care program that covers children from low- and moderate-income families could dry up, potentially leaving millions uninsured, without renewed federal support.
Lawmakers in Massachusetts are bracing for that possibility, should Congress let funding lapse or tighten eligibility rules for the Children’s Health Insurance Program, also known as CHIP. But plans for the state to pick up the tab, which could run in the hundreds of millions of dollars, face an uphill battle.
Federal support for the program serving families who earn too much to qualify for Medicaid is set to expire Sept. 30. Unless Congress votes to renew funding, advocates say 8.4 million children nationally — including about 160,000 in Massachusetts — could be left without affordable health care coverage.
“We’re really concerned,” said Suzanne Curry, a senior policy manager with the Boston-based advocacy group Health Care for All. “There’s a lot of kids depending on this program, and a lot of uncertainty about what is going to happen in Washington, so we need to prepare for that.”
Sen. Barbara L’Italien, D-Andover, is primary sponsor of a measure to allow the state to take over the program and pick up the federal government’s share.
Regardless of whether Congress acts, L’Italien said the measure on Beacon Hill ensures that “children from birth through 18 years old, as well as pregnant women, will continue to receive health care.”
“While Congress has authorized and reauthorized the Children’s Health Insurance Program in the past, we’re in less-certain times at the federal level right now,” she said in a statement.
The state got nearly $536 million in the last fiscal year for the program, according to the U.S. Department of Health and Human Services. The prior year, it got $401 million from the federal government.
The state adds about 12 percent of the funding for the program in Massachusetts. During the last fiscal year, the program’s budget here was more than $626 million.
Health care experts say picking up the slack for the federal government would stretch the state.
“Medicaid is already more than 40 percent of the state’s budget,” said Joshua Archambault, a senior fellow on health care at the Pioneer Institute in Boston. “They would have to take away a sizable amount of money from education, public safety and other areas to keep that program afloat.”
Gov. Charlie Baker and legislative leaders are under growing pressure to reduce spending on health care programs, which rose by 3.9 percent to $57.2 billion in 2015.
Adding to criticism of the Children’s Health Insurance Program is recent data showing that parents of some children in the plan get private insurance through their employers.
“That’s raised questions about why kids are on public insurance when their parents have private coverage,” Archambault said. “It would probably be cheaper and easier to have them on the same plan.”
Health care advocates say funding the children’s health program is one of many thorny issues that Congress will confront, including Republican-led efforts to repeal the federal Affordable Care Act.
If the latter happens, the state could lose nearly $9 billion a year in money for MassHealth, the Health Connector and other programs serving low-income residents, advocates say.
Bruce Lesley, president of the Washington D.C.-based advocacy group First Focus, said national health care advocates are gearing up to fight for the children’s insurance plan, but he’s worried that their efforts will fall by the wayside amid a push to prevent a repeal of the federal healthcare law.
“Everyone is focused on the repeal of Obamacare,” he said.
Lesley said the Children’s Health Insurance Program has strong, bipartisan support, and talk of eliminating funds to cover low-income children can be a political minefield. Congress wrangled over dismantling the program in 2015, but ultimately voted to reauthorize it for another two years.
“People like the program and don’t want to do any harm to it,” he said. “It’s extremely popular.”
Even if Congress renews the program’s funding, that could come with strings.
House Republicans have pitched a scaled-down program that stops covering children above 300 percent of the poverty line and reduces coverage for those at or above 250 percent.
Currently, 17 states cover children with family incomes of at least 300 percent of the federal poverty level. In Massachusetts, a family of four must earn less than $72,900 to qualify.
U.S. Rep. Niki Tsongas, D-Lowell, a longtime supporter of the program, blames congressional Republicans for seeking to “strip health care protections from the most vulnerable populations.”
“If CHIP is allowed to lapse, it would prevent kids from getting the health care they need and signal a shocking dereliction of duty on the part of Republicans,” she said.
L’Italien said she hopes Congress reauthorizes the program, but said the state needs to prepare for uncertainty.
“Hopefully they continue to understand the value of providing health insurance to young people,” she said. “If not, this bill will become necessary to sustain coverage to kids who need it.”
Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at firstname.lastname@example.org.