Low Income Kids will be Hit Hardest if Effort to Raid CHIPRA Performance Bonuses Succeeds – Say Ahhh! A Children’s Health Policy Blog

In my house, I have a general policy for my three boys
that they can’t use the words “stupid” and “dumb” unless they are truly
warranted (e.g., you can’t call your brother stupid for forgetting the napkins
when setting the table, but, I let it go when they decided that Anthony Weiner
had acted stupidly).  Still, when the
Energy and Commerce Committee voted last week to cancel performance bonus
payments to states that enroll more low-income children in health care coverage,
I had a hard time restraining myself from using this type of harsh

Created by the Children’s Health Insurance Program
Reauthorization Act (CHIPRA) of 2009, the bonuses reward states for
demonstrating concrete success in enrolling low-income uninsured children in
Medicaid.  To qualify, states must adopt
one of a series of measures that simplify enrollment in coverage and reach
enrollment targets.  To date,
the bonuses have worked exactly as intended – rewarding states for tackling the
challenge of making sure that the lowest-income children in this country are
connected to coverage.  While the bonuses
only modestly offset the cost of successfully enrolling more eligible children
in Medicaid, they have had an “outsized” impact by inspiring states to make it
easier for eligible children to be enrolled in affordable health plans.  States across the country seem to appreciate
the additional fiscal help, modest thought it is, as well as the all-too-rare
public recognition of their hard work and innovation.  Indeed, states from Washington and New Mexico
to Louisiana and New Jersey have enjoyed the benefits of the bonuses (See map
below).  Last year, 23 states across the
country received a little over $296 million in bonuses. 


The cancelation of the performance bonuses is certainly
not the only (or even the most problematic) provision included in the Energy
and Commerce Committee’s recent mark.  To
the contrary, as my colleague, Martha Heberlein has described elsewhere, the repeal of the stability protections (aka “maintenance-of-effort
requirement”) would be potentially devastating to America’s children.  And, if the committee’s decision to eliminate
federal Exchange grants were adopted and signed into law, it would wreak havoc
with health reform implementation. 

But, the Energy and Commerce committee decision to go
after the performance bonuses is very troubling. It could imperil the nation’s
recent success in driving the uninsured rate of children to record lows by removing an important incentive to continue to make progress.  Plus, ironically, during debate over
reauthorizing CHIP, President Bush and a number of members of congress argued
against the broader bill on the grounds that it didn’t do enough to enroll the
poorest children in coverage.  Connecting
the poorest children with affordable health care coverage is the primary goal
of the CHIPRA performance bonuses.  So,
without stooping to call the idea stupid or dumb, it is safe to say that
eliminating the performance bonuses is short-sighted and contradicts the
objective of making coverage of the poorest children a top priority for this

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