Senate Finance Subcommittee on Health Care Hearing
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Thank you Chairman Rockefeller, Ranking Member Roberts, and members of the
I would like to start by recognizing Chairman Rockefeller for his lifetime achievements in championing an array of issues, including child health, foster care, Supplemental Security Income (SSI), and child poverty, that have been critically important to the children of
Mr. Chairman, CHIP has been an undeniable, bipartisan success story. As those of us that worked on the issue back in 1997 can attest, the lack of health insurance coverage among children was a national tragedy.
In fact, one in seven of our nation's children had no health insurance coverage and, in places like
These were not isolated incidents. An
The report concluded:
Access to health care can influence children's physical and emotional growth, development, and overall health and well-being. Untreated illnesses and injuries can have long-term - even lifelong - consequences.
And, according to a 1991 landmark report entitled Beyond Rhetoric: A New American Agenda for Children and Families by the bipartisan
Perhaps no set of issues moved members of the
If this nation is to succeed in protecting children's health, there must be a major commitment from families, communities, health care providers, employers, and government to meet children's basic health needs and to ensure that all pregnant women and children have access to health care.
CHIP Is a National Success Story
Mr. Chairman, that commitment to protecting the health of our nation's children was answered by
Through the leadership of Chairman Rockefeller and Senators Hatch, Kennedy, Chafee, Roth, and Moynihan in the Senate, the creation of CHIP was the result of a year-long debate and series of compromises that led to the commitment of
The bipartisan discussions that senators had over the course of that year were inspiring. Although there were some disagreements about how the program should operate and compromises had to be found, the fact is that all of the members of the
Democrats and Republicans agreed that investing in the health of our children is investing in America and its future. They recognized that when our children develop and thrive, we are paving the way for our country's next generation of workers and leaders. And when our kids aren't healthy, they do not learn and our nation will fail to stay the world's leader in innovation. That is why CHIP has proven to be so important.
Toward these goals, CHIP has been a rousing success story, as the uninsured rate for our nation's children has been cut in half - from 14 percent in 1997 to just 7 percent in 2012 (see Figure 1 from
This past year, according to the
These success points exceed the expectations of many at the time CHIP was passed. For example, days before CHIP was passed by the
However, although
CHIP is also a program that has been tailored to the specific needs of children and pregnant women in the individual states. Recognizing that wages and health care costs are far different across the states, CHIP gives states discretion in working with their providers and insurance plans to set premiums, cost sharing, benefits, income eligibility levels, and provider networks for children and pregnant women rather than having a one-size-fits-all federal standard.
The downside to state flexibility has been that progress has been somewhat uneven. In 43 states and the
In contrast, the rates of uninsured children, although much improved, tend to remain highest in the Southwest, where I grew up, and the South. Only seven states still have uninsured rates for children than exceed 12 percent and they are:
Fortunately, we continue to make progress in closing in on the "finish line" of covering all kids. According to a report by
Approximately 88 percent of
Nonetheless, an estimated 5 million of the remaining 7 million uninsured children in the country are eligible for but not enrolled in
One of the hallmarks of CHIP has been the willingness of leaders on both sides of the aisle to work together to improve the enrollment of these children. For example, President
Furthermore, Express Lane Enrollment is a streamlined process that facilitates
According to an evaluation of the program by
CHIP Is, by Definition, Child-Focused
CHIP is, as you know and by definition, child-focused and that has been a critical factor in its success for children. If you have talked to pediatricians or been inside a children's hospital, within the first five minutes, you have likely heard the mantra that "children are not little adults." As the IOM committee that issued the report entitled America's Children:
Mr. Chairman and members of the
According to the Assistant Secretary for Planning and Evaluation (ASPE) at the
Similarly, a 2012 CHIP evaluation report by
Therefore, CHIP has successfully expanded health coverage to kids, tailored services and benefits to address the special health care needs of children, improved access to health care, and reduced financial burdens for low-income families. In the face of a raft of bad news for children, including the fact that 22 percent of our America's kids are living in poverty, CHIP stands out as a shining success story.
In contrast, while the health of children and pregnant women are the first and only thought in CHIP, they can be an afterthought in the adult health care system, including private employer plans, the Federal Employees Health Benefits Program (FEHBP), and Marketplace exchange plans.
When I worked on
Worse, during one enrollment cycle, D.C.'s
Subsequently, with the advent of the insurance exchanges in the Affordable Care Act (ACA), although we strongly support important provisions related to bans on pre-existing condition exclusions or lifetime caps that were so harmful to a number of children, there remains a number of issues that need to be worked out for kids. For example, just this past week,
CHIP Plays a Key Role in Reducing Health Disparities
CHIP, in partnership with
According to the HHS Action Plan to Reduce Racial and Ethnic Health Disparities, one of the foremost action strategies of the Secretary is to "increase the proportion of people with health insurance and provide patient protections in
As noted earlier, strategies that include outreach and enrollment grants and the use of Express Lane Eligibility are important mechanisms to reduce the number of uninsured and disparities in health coverage.
One example of this is to better utilize community health workers or "promotoras" to help uninsured but eligible children get enrolled into coverage but to also assist families in navigating the health care system to ensure their children receive the insurance benefits and public health services that their kids need.
"Such activities will have a focus on reducing disparities in coverage for racial and ethnic minorities and those experiencing language barriers," according to the Action Plan. "Linking enrollment of children and families in CHIP and
Therefore, in addition to extending CHIP's funding, it is important that
And, beyond coverage improvements, a study published by the
Rural Children Would Stand to Lose the Most if CHIP Expires
As a former Senate staffer to the
In this study by
. The percent of children who lack health insurance is the same in both urban and rural areas but the source of insurance coverage differs.
. Of the fifty counties with the highest rate of uninsured children, 45 are rural counties.
. In 2012, 52 percent of rural children lived in low-income families (those with income less than 200 percent of the poverty line) compared to 42 percent of urban children.
. Children in rural areas are more reliant on health insurance from public sources. In 2012, 47 percent of rural children are covered by public insurance compared to 38 percent of urban children.
Due to the higher levels of child poverty in rural America, where over half the children live in families with income below 200 percent of the poverty line, the uninsured rate for children would be much higher if it were not for the health coverage offered by
In fact, if CHIP were to be allowed to expire, it is clear the result would be negative to both rural and urban children, but that the children in rural America would stand the most to lose and would be disproportionately harmed.
Even worse, for those rural communities that already have some of the highest uninsured rates for children in the country, the loss of CHIP would compound what is already an enormous problem.
CHIP is Overwhelmingly Popular with the American People
In light of the importance that CHIP plays in the lives of millions of children and the many successes that CHIP has had since its inception 17 years ago, it is not surprising that the American people know a good thing when they see it.
In
Four years later, another Election Eve poll by
And in May of this year, a poll by American Viewpoint found that voters continue to support extending CHIP by a margin of 74-14 percent.
At a time when one-quarter of the American people seem to be so disenchanted and cynical that they oppose just about everything, it is a testament to CHIP that it has maintained such strong bipartisan support over the years. The same is true when the pool breaks down support by age, gender, and racial groups.
In the American Viewpoint poll, for example, the level of support versus opposition to extending CHIP is:
. 80-10 percent among Democrats
. 66-19 percent among Republicans
. 75-15 percent among Independents
. 66-18 percent among self-identified "
. 77-12 percent among women
. 71-16 percent among men
. 80-9 percent among adults 18-29 years of age
. 72-15 percent among adults over the age of 65
. 72-14 percent among whites
. 79-14 percent among African-Americans
. 79-12 percent among Hispanics
. 79-13 percent among parents
. 73-16 percent among grandparents
. 71-15 percent among adults without children
. 76-14 percent among urban voters
. 74-15 percent among suburban voters
. 72-13 percent among rural voters
. 75-15 percent in states where both senators are Republicans
. 71-13 percent in states where the senators are split
. 76-14 percent in states where both senators are Democrats
No matter how you break it down, American voters support CHIP by wide margins.
Unfortunately, CHIP's 8 Million Children Are at Risk
Although CHIP celebrated its 17th birthday this year and has achieved a remarkable record of success, funding for the program expires on
Unfortunately, with the establishment of the
In analyzing the question of what would happen to the health coverage of 8 million children if CHIP were allowed to expire, the
One of the major factors, according to researchers at the
But, even for those that would be able to make the leap from CHIP to the qualified health plans (QHPs) in the Marketplaces, the
In their report entitled Comparison of Benefits and Cost Sharing in Children's Health Insurance Programs to Qualified Health Plans, the
* Average Cost Sharing: In every state, children covered by CHIP would have significantly lower levels of cost sharing than through plans offered on the exchanges. For example, the
* Total Out-Of-Pocket Costs: Children with special health care needs that are currently served by CHIP would be hardest hit by a transition to QHPs. In some states, children with special health care needs could go from paying
* Coverage of Benefits and Services: CHIP covers more child-specific services and benefits with fewer limits than QHPs. For example, CHIP covers more child-specific services and benefits, such as pediatric dental, vision, hearing, autism services, habilitation, etc., than QHPs in the exchanges.
As an example, on the issue of pediatric dental coverage, QHPs can exclude dental benefits if a stand-alone dental plan is available in that state. As a result, only 40 percent of QHPs that were reviewed offer pediatric dental as an embedded benefit in the QHP. In more than half of the states studied, children moving from CHIP plans into QHPs would likely need to purchase separate stand-alone dental plans in order to have comparable coverage, which means that families would face additional costs for the separate premium required in a stand-alone dental plan. CHIP is superior
* Benefit Limits or Caps: Even with respect to benefits that are provided through both CHIP and QHPs, the
For instance, with respect to physical, occupational, and speech therapy, the Wakely study found that both CHIP and QHPs cover all of these services. However, four-fifths, or 80 percent, of QHPs impose utilizations limits and caps for these services, which is in sharp contrast to 42 percent of CHIP plans. CHIP is superior
In all 35 states studied and analyzed by the
* Child-Centered Networks: But, even beyond the lower cost-sharing and stronger benefits, CHIP is important to protect because the health provider networks in CHIP are made up largely with doctors, nurses, and hospitals that have pediatric and maternal child health expertise. They are educated and trained to recognize and treat the unique array of physical, mental, social, and emotional developmental needs of children as they grow from infancy through adolescence. This focused attention and expertise in addressing children's special needs stands in sharp contrast to the situation in other types of adult-centered coverage.
For example, while a CHIP quality review panel's time is spent almost entirely reviewing and discussing ways to improve child health, child advocates have found it difficult to even get even one pediatric expert to be named to such a panel in adult-centered networks or to get time focused on the needs of children.
According to analysis by the
Conclusion and Recommendations
Toward the end of World War I, the
Over the years, our nation's leaders have chosen to make some key strategic investments toward these goals of improving the lives of children and securing our nation's long-term success. In 1997, even amidst a discussion to pass a major deficit reduction package, the
This has proven to be a wise investment, as CHIP has - in partnership with
CHIP has also made important strides in reducing health disparities. And, despite two recessions and the resulting increase in child poverty, CHIP and
In short, CHIP works and works well.
Nevertheless, with the passage of the ACA, there are some that have questioned whether we or not we should fold CHIP into the Marketplace exchanges. However, when you look at all the evidence, research from the
Much would need to be improved in the exchanges and the law before
Consequently, over 400 organizations representing all 50 states have signed a joint letter urging
Recommendations
Specifically, we urge
In fact, although CHIP funding does not expire until
We would also urge the extension of outreach and enrollment grants, the pediatric quality standards, and Express Lane Eligibility (which expires in
And, although it is a
In closing, I would like to once again thank Chairman Rockefeller and Ranking Member Roberts for holding this important hearing about children's health. This Committee has always provided the leadership on CHIP and we look forward to working with you all toward its extension.
I would also like to personally recognize and thank Chairman Rockefeller for his outstanding career as a champion for our nation's most vulnerable citizens: its children. We appreciate all that you have done over the years for kids. Thank you!
Read this original document at: http://www.finance.senate.gov/imo/media/doc/Finance%20Cmte%20CHIP%20Testimony%2009-16-14%20Bruce%20Lesley.pdf
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Senate Finance Subcommittee on Health Care Hearing
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