The Tri-Committee Health Reform Bill: Implications for Children – Say Ahhh! A Children’s Health Policy Blog

On Friday, almost two weeks ago now, the three major committees in the House with jurisdiction over health reform put out a draft legislative proposal, known as “The Tri-Committee bill.”  We’ve now read the 852-page document a few times, and think it would make giant strides in providing access to coverage to millions more people and transforming the country’s health care delivery system.  Of particular note for kids, it includes:

  • Major expansions in access to affordable coverage for their parents and other adults.  (Click here for just a few of the articles showing a clear link between how children fare and the health and stability of their parents.);
  • Continued coverage of children through Medicaid with its strong, child-specific benefit package;
  • Increases in Medicaid reimbursement rates; and
  • A guarantee that no child born in a U.S. hospital leaves without insurance.  (For more details on these and other provisions, see our Fact Sheet on the Tri-Committee bill.)

At the same time, the Tri-Committee bill could be further strengthened to ensure that all children have access to high-quality, affordable coverage.  Of particular note – the Tri-Committee bill allows the remarkably successful Children’s Health Insurance Program (CHIP) to expire just as health reform becomes operational.  This means that some 9 million children will have to move from CHIP coverage to Exchange plans on Day 1 of health reform and, as of yet, there is no guarantee that the new coverage they get will be comparable.

It may well be the case that the CHIP program eventually becomes a charming relic under health reform, no longer needed in a country where there is access to comparable coverage for children and adults alike through an Exchange. But, it is risky to disband CHIP before being sure of this outcome, especially given the promise of reformers to allow people to keep their coverage if it is working well.  As President Obama said on June 11, 2009 in Green Bay, Wisconsin, “My view is that reform should be guided by a simple principle:  we fix what’s broken and build on what works.” 

The House bill would be stronger for kids if it took a few simple steps to build on the gains in children’s coverage we’ve secured in recent years.  1) Guarantee that children will receive comparable coverage and cost-sharing protections if they are moved from CHIP to new Exchange plans; 2) Continue running CHIP until we have a few years of experience with the Exchange plans, and dismantle the program only after we know that the they work as well for kids, and 3) Develop a plan for a smooth transition of the 9 million kids from CHIP to the Exchange – we don’t want to repeat the brutal mistakes of the past that occurred when we tried to abruptly move millions of low-income seniors and people with disabilities from Medicaid drug coverage into new Medicare Part D plans. (Read more about the Medicare Part D move here and here and from Robert Pear here.)  

Also, the Tri-Committee bill could go further in tackling the key reason that millions of our children remain uninsured – Nearly two-thirds of the nine million children without coverage in this country are already eligible for Medicaid or CHIP, but aren’t enrolled because their parents face red-tape barriers to signing them up for and keeping them in coverage.  The good news is that there are tested and well-known strategies for tackling this problem, including use of “no wrong door” enrollment for people seeking coverage; providing 12-months of guaranteed coverage; requiring states to use simplified, electronic verification of eligibility information; and making maximum use of auto-enrollment strategies.  These are the quickest, easiest and most cost-effective way to cover most of America’s uninsured children but they are not all included in the House bill. 

House leaders still have a few more shots at improving the strong start they’ve already made on health reform, and we’re optimistic that they’ll do so.  There is a deep, historical commitment in Congress to covering children and at the White House, and widespread support from the American public to ensure that all of our children have high quality, affordable care.  As President Obama said when he signed the legislation renewing the CHIP program on February 4, 2009, “I refuse to accept that millions of our children fail to reach their full potential because we fail to meet their basic needs.  In a decent society, there are certain obligations that are not subject to tradeoffs or negotiations and health care for our children is one of those obligations.”


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