Will Congress Keep KidsCare Alive?
Graciela Montenegro doesn’t have to speculate about her daughter losing health insurance. She already knows what it’s like.
“It was a really hard time when you have to take your kid to see a specialist and you don’t have the $350 in your pockets to pay for a visit,” Montenegro said.
Montenegro’s daughter had been diagnosed with high blood pressure and asthma. She needed specialists for her kidneys and liver, plus her allergies. All of that had been covered by Arizona’s version of the Children’s Health Insurance Program (CHIP), known as KidsCare.
“We had to cancel some of her appointments at that time," Montenegro said. "It was a little stressful, finding out what are we going to do, what if she doesn’t have insurance."
Enrollment had reached more than 40,000 when Arizona lawmakers froze the program during the Recession to deal with the budget crisis. It temporarily reopened several years later during the roll out of the Affordable Care Act, which is how Montenegro’s daughter got covered. But once that program expired, Arizona was the only state without an active CHIP program.Then in 2016, Montenegro was able to re-enroll her daughter and start paying into the program.
“You know what, it's worth it. I am going to take her back to see her specialist again. I am happy with that,” she said.
The state has struggled with a high number of uninsured children in recent years, but that’s beginning to change.
The Affordable Care Act offered states a lot of money to cover families like Montenegro’s. That came in the form of extra funding for Medicaid, for example, to raise eligibility, and for KidsCare. The federal government is paying the entire bill for Arizona, one of the reasons why lawmakers felt OK reopening the program.
But Joan Alker of Georgetown’s Center for Children and Families said all of that could change this year in Congress.
“All three legs of the coverage stool in Arizona for kids — Medicaid, CHIP and the Affordable Care Act — are under threat,” Alker said.
Those three legs are meant to ensure children at every income level can get health care. But the House replacement — the American Health Care Act — would slash more than $800 billion from Medicaid, roll back the expansion and cap the program, so it’s no longer an open-ended funding stream.
The bill doesn’t mention CHIP, but Congress needs to reauthorize that program by the end of September. Alker believes there’s bipartisan support to take some action, but that might not be enough for Arizona.
“Unfortunately, we do have proposals not just from President Trump and his budget, but from previous House proposals around CHIP that it will be cut and that’s going to be a problem,” Alker said.
When Arizona reopened its program, lawmakers put in a trigger that if federal funding dips, the state immediately freezes enrollment.
This prospect — taking away coverage just shortly after giving it — led some to caution against restarting KidsCare, even though it was free.
“You create a constituency of 30,000 … could be as much as 50,000 people. And now you pull the trigger to take them off?" former Arizona State Senate President Andy Biggs said on Arizona Horizons in 2016. "The answer is that’s not going to happen. Nobody’s going to pull that trigger."
Biggs, now a Congressman, may be an outlier for Arizona. He was the only Republican from the state to vote against the House replacement bill, saying it didn’t go far enough to repeal the ACA.
Meanwhile, the U.S. Senate is quietly working on its own bill, although that isn’t public.
With all the moving parts in Congress, some in the medical community worry that Arizona will soon be forced to pull that trigger — by state law.
Dr. Delphis Richardson, past president of the Arizona chapter of the American Academy of Pediatrics, said KidsCare provides a “bridge” for families that still quite can’t quite afford private insurance, but don’t qualify for Medicaid, either.
“People were foregoing normal health care or they were over utilizing the emergency room," Richardson said. "The families would have to deal with exorbitant costs that could have been foregone if they had been able to access care at an earlier time or had preventive care.”
He already sees that changing.
Nearly 20,000 children alone have joined KidsCare since the end of last year. It’s a number that’s likely to grow so as long as the programs stays afloat.