First Focus Campaign for Children is pleased that the Farm Bill conferees have produced a bipartisan farm bill agreement that rejects harmful cuts to the Supplemental Nutrition Assistance Program (SNAP) and protects the ability of low-income families with children to put food on the table. The following statement comes from said First Focus Campaign for Children president, Bruce Lesley:

“SNAP is the first line of defense against food insecurity for 19 million children. This bill is a clear repudiation of the House bill, which would have made it harder for hundreds of thousands of families with children to access SNAP. We are encouraged that--instead--lawmakers were able to come together from both sides of the aisle to support this critical program, which not only fights child food insecurity, but lifted 1.5 million children out of poverty last year alone.”

First Focus Campaign for Children looks forward to continuing to work with lawmakers to promote policies that not only protect SNAP, but also strengthen its ability to prevent children from experiencing hunger and poverty.

The Senate to Vote on the Tax Cuts and Jobs Act

The Senate is poised to vote on its version of the Tax Cuts and Jobs Act this week. Though the Senate bill varies significantly and its from its counterpart in the House (which passed in spite of fifteen harmful provisions to kids and families on November 16), the measure will still dramatically overhaul the existing tax code. The Senate bill’s writers claim that it will provide meaningful tax relief to millions of families. However, initial analysis of the bill suggests that the bulk of its tax breaks flow to wealthy families and corporations in the long term. For middle and low income families, especially those in poverty, modest tax relief is temporary—and it comes at a steep price.

Nine Provisions in the Senate Bill That Hurt Children:

1. Increase to the Deficit will force Spending Cuts: The tax bill would increase the federal deficit by 1.49 trillion dollars over the next decade. According to the Tax Policy Center, these tax cuts will have to be paid for somehow over the long term—probably with some combination of increases in other taxes or cuts in spending. Meanwhile, the bill’s writers have signaled that though some 35 components of the Senate bill are set to expire in eight years, they expect that they would be extended—which would put the bill’s actual long-term cost at far above 1.49 trillion.

How it hurts kids: Programs that support kids and families—like food assistance, Medicaid, housing, and education investments—could all be at risk.

1. Deficit Spending Now Hurts Children Later: As Maya MacGuineas of the Committee for a Responsible Federal Budget explains, past tax cuts have failed to spark economic growth dollar for dollar—generally leading to larger budget deficits and lower revenue. This is bad for the economy: debt not only suppresses economic growth, it suppresses future wages. The Congressional Budget Office estimates that average income in 30 years will be $5,000 less a year if the national debt continues to grow on its current trajectory.

How it hurts kids: by suppressing future economic growth and earnings, children will pay the high price of the tax bill’s $1.49 trillion addition to the national debt.

1. Forces Another Tax Fight in Eight Years: The Senate Tax Bill does promise a tax break for most families at every income level in its first few years. However, to avoid violating the Senate’s requirement that the bill not increase the deficit by more than $1.5 trillion over ten years, most of the provisions that provide tax relief to children and families—such as the reduced rates and expanded child tax credit—are set to expire in eight years. Furthermore, the largest share of this temporary tax relief is directed to the wealthiest families, as the Tax Policy Center illustrates.

How it hurts kids: While the bill’s writers are confident that these provisions would be extended due to their popularity, there are no guarantees. As a result, the expiration date creates uncertainty in the tax code. Even worse, it will force kids and families to fight to retain their tax breaks at the expense of a massive deficit increase.

1. Using the Chained Consumer Price Index (CPI) will Increase Tax Burden: One technical, but quite consequential, change in the tax bill is its replacement of the current measure of inflation—the CPI—to the Chained-CPI. The Chained-CPI is a less generous measure of inflation—and thus it understates the role that inflation plays in increasing incomes. Using this measure to determine tax bracket would, the Tax Foundation explains, place families into higher tax brackets when they don’t deserve to be there. At the same time, tax deductions that are linked to the chained CPI (such as the Earned Income Tax Credit and Standard Deduction) wouldn’t grow as quickly.

How it hurts kids: Not only would families find their tax burden increased substantially over time due to this “bracket creep,” says Howard Gleckman, but low-and-moderate income families would also see the value of their tax deductions eroded over time.

1. Strips the Child Tax Credit (CTC) from Over One Million Children: Currently, immigrant parents who file their taxes with an Individual Taxpayer Identification Number (ITIN) can claim the CTC on behalf of qualifying children. The Senate tax bill would change the eligibility rules so that only children with a social security number are eligible for the entire child tax credit. This provision targets over one million immigrant children who lack social security numbers, many of whom are among the Child Tax Credit’s most economically vulnerable recipients, according to the Center for Law and Social Policy. It could also add a barrier to accessing the Child Tax Credit for families with newborns or adopted children if they experience unexpected delays in receiving a social security number.

How it hurts kids: Over one million immigrant children would lose the Child Tax Credit, with possible effects on families with newborns and adopted children experiencing delays in receiving social security numbers for their children.

1. Removes the Personal Exemption for Five Years: The current tax code allows families a tax exemption of $4,050 per person ($4150 in 2018.) Even with the tax bill’s increase of the standard deduction to $18,000 for head of household filers and $24,000 for married joint filers, larger families (single parents with three or more children, married parents with two or more children) would see their taxable income increase, which prevents some from benefiting fully from the bill’s expansion of the child tax credit. Furthermore, large families whose children are in college and are too old to receive the credit would not be able to make up for the loss of the personal exemption with the child tax credit.

How it hurts kids: Removing the personal exemption could penalize larger families, especially those with children in college

1. Repeals The Entire State and Local Tax (SALT) Deduction: The Senate Tax Bill ends the federal deduction for state and local income, sales, and property taxes. According to the Government Finance Officers Association, the loss of this deduction would likely force states to lower their tax rates to reduce the additional tax burden it would place on residents.

How it hurts kids: Lower state and local taxes would make it harder for states — many of which already face serious budget strains — to raise sufficient revenues in the coming years to invest in K-12 education and child welfare services, both of which rely heavily on state and local funding. The Senate’s positive step to increase the educator expense deduction—a move that would double the current $250 deduction available to teachers who self-supply classroom supplies—will not be enough to counteract the loss that schools will face due to diminished state and local funding streams.

1. Diminishes the “Orphan Drug” Tax Credit (ODTC): The ODTC allows drug manufacturers to claim a tax credit of 50 percent of the qualified costs of clinical research and drug testing of orphan drugs, which treat rare diseases. Unlike the House, which sought to repeal the credit entirely, the Senate bill makes a series of changes that, according to The National Organization for Rare Disorders, cut the incentive in half, could limit those who qualify, and may interrupt current clinical trials.

How it hurts kids: Even though children comprise only 23 percent of the US population, they represent 50 percent of the Americans suffering from the rare diseases that “orphan drugs” treat, and The American Academy of Pediatrics argues that this credit has spurred the development of drugs specifically targeting children with rare diseases in the past decade—meaning kids with rare diseases will suffer disproportionately if it is weakened.

1. Repeals the Affordable Care Act’s Individual Mandate: Another controversial provision in the Senate tax bill is the repeal of the Affordable Care Act’s penalty for individuals who can afford insurance but opt not to purchase it. The mandate is an important measure for keeping healthy individuals in the insurance marketplace, which keeps premiums affordable. The Congressional Budget Office estimates that without the mandate, thirteen million fewer people will access health insurance within ten years.

How it hurts kids: The repeal of the Mandate means some families will no longer opt to purchase health insurance through the Marketplace—meaning they also would no longer receive government subsidies to purchase insurance. The Joint Committee on Taxation scores the loss of the subsidies as a net tax increase starting in 2027 for families earning less than $75,000 (half of all US households would also see a tax increase in that same year independent of the mandate repeal). Furthermore, undermining the insurance market could drive the cost of premiums up by 10 percent in 2019, hurting families who remain in the individual marketplace, and would likely also lead to 5 million fewer participants in Medicaid. The Congressional Budget Office estimates that as a result, the federal government would spend less money on the poorest individuals—those earning less than $30,000 a year—as early as 2019.

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Three Pieces of the Senate Bill Have Potential to Work Better for Kids:

The Senate tax bill is flawed, but it has at least two policy provisions that could be improved upon to better benefit kids and families:

1. Make the Child Tax Credit (CTC) Increase Permanent and Refundable at the First Dollar: The Senate bill increases the current CTC from $1,000 to $2,000, shifts the earnings threshold for receiving the credit from $3,000 to $2,500, increases the phase-out threshold to $500,000. The expansion is a marked improvement over current law for some families, but not those who are working-class or living in poverty, argues Senator Marco Rubio. Because the increase is not refundable, it won’t apply to families living under the poverty threshold—the very ones who would benefit most from the additional income. Though the bill indexes the refundable portion of the credit to the chained-CPI, it would take decades for it to experience a commensurate increase to the non-refundable portion. Meanwhile, the Senate’s changes to the earnings thresholds showcase skewed priorities. Those earning less than $10,000 a year would receive what the Center on Budget and Policy Priorities calls a “token” CTC increase of $75—while someone making $500,000 would now qualify for a full $2,000 credit per child.

How it could work better for kids: Instead of increasing the phase-out level, which disproportionately favors wealthy families, the bill should instead make the entire $1,000 Child Tax Credit increase refundable, starting at the taxpayer’s first dollar of earnings. Not only would this better target the credit to those who need assistance the most, but estimates from the Century Foundation suggest that it would increase the cost of the Child Tax Credit by less then $59 billion a year—cheaper than the Senate’s current proposal, which is estimated to cost an average of roughly $68 billion a year.  

1. Pursue a More Comprehensive Paid Leave Program: The Senate bill also creates a two-year pilot program for a paid leave tax credit. The credit would apply to businesses offering full-time employees who earn less than $72,000 a year at least two weeks of paid family and medical leave each year. To receive the credit, employers must pay a minimum of 50 percent of wages, for which they receive a 12.5 percent credit that increases by .25 percent for every additional percentage point of wage replacement. However, the credit maxes out at 25 percent, and it can go to companies already implementing paid leave policies. Aparna Mathur with the American Enterprise Institute points out that on the whole, the credit may not be enough to make paid leave affordable for companies who don’t currently provide it—and thus, may fail to meaningfully expand access to this vital support.

How it could work better for kids: While it is encouraging that lawmakers are attempting to incentivize increased access to paid leave programs, modest employer tax credits are unlikely to spark the kind of comprehensive paid leave that would benefit low-earning families. Lawmakers looking to create equitable access to paid leave should embrace plans like the FAMILY Act (sponsored by Congresswoman DeLauro (D-CT) and Senator Kirsten Gillibrand (D-NY) which would combine employer and employee payroll contributions to create a shared fund for affordable and adequate paid leave for employers of all sizes.

1. Embrace Potential Amendments to Improve the Child and Dependent Care Credit (CDCTC): The Senate bill does not make any changes to the CDCTC, but several options exist for strengthening and expanding access to this credit. Several lawmakers support the PACE Act (sponsored by Senators Burr R-NC, and King-I, ME) and may introduce it as an amendment to the tax bill when it is on the Senate floor.

How it could work better for kids: The PACE Act would increase the value of the CDCTC, make it refundbale, and index it to inflation. Lawmakers should take the opportunity to support targeted improvements to the CDCTC to help families mitigate the skyrocketing cost of childcare.

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The Bottom Line: This Tax Code Overhaul Doesn’t Invest in Children

We urge lawmakers to pursue bipartisan tax reform that prioritizes moderate and low-income families in the long term, without jeopardizing government spending that provides crucial supports for children.

Recently, the House of Representatives passed its tax bill to dramatically overhaul the existing tax code with a 227 to 205 vote. The bill’s supporters claim that the Tax Cuts and Jobs Act (H.R. 1) will provide meaningful tax relief to millions of families. However, initial analysis of suggests that for families with children—especially those who are low-income—this is not the case. In fact, First Focus Campaign for Children has identified fifteen provisions that harm kids and families.

Fifteen pieces of the Tax Bill that Hurt Children:

1. Increase to the Deficit will force Spending Cuts: The tax bill would increase the federal deficit by 1.49 trillion dollars over the next decade. According to the Tax Policy Center, these tax cuts will have to be paid for somehow over the long term—probably with some combination of increases in other taxes or cuts in spending.

How it hurts kids: Programs that support kids and families—like food assistance, Medicaid, housing, and education investments—could all be at risk.

2. Deficit Spending Now Hurts Children Later: As Maya MacGuineas of the Committee for a Responsible Federal Budget explains, past tax cuts have failed to spark economic growth dollar for dollar—generally leading to larger budget deficits and lower revenue. This is bad for the economy: debt not only suppresses economic growth, it suppresses future wages. The Congressional Budget Office estimates that average income in 30 years will be $5,000 less a year if the national debt continues to grow on its current trajectory.

How it hurts kids: by suppressing future economic growth and earnings, children will pay the high price of the tax bill’s $1.49 trillion addition to the national debt.

3. Using the Chained Consumer Price Index (CPI) will Increase Tax Burden: One technical, but quite consequential, change in the tax bill is its replacement of the current measure of inflation—the CPI—to the Chained-CPI. The Chained-CPI is a less generous measure of inflation—and thus it understates the role that inflation plays in increasing incomes. Using this measure to determine tax bracket would, the Tax Foundation explains, place families into higher tax brackets when they don’t deserve to be there. At the same time, tax deductions that are linked to the chained CPI (such as the Earned Income Tax Credit and Standard Deduction) wouldn’t grow as quickly.

How it hurts kids: Not only would families find their tax burden increased substantially over time due to this “bracket creep,” says Howard Gleckman, but low-and-moderate income families would also see the value of their tax deductions eroded over time.

4. Insufficiently Increases the Child Tax Credit: The tax bill increases the current Child Tax Credit from $1,000 to $1,600, with an additional $300 credit per parent. The addition of the Family Credit is a marginal improvement over current law, but not for families with children who are working-class or living in poverty, argues Senator Marco Rubio. Because the increases are not refundable, they won’t apply to families living under the poverty threshold, and the $300 parent credits would expire after five years. The proposal to index the refundable portion to inflation is also insufficient, as it uses a less generous estimate and ceases upon reaching $1600.

How it hurts kids: This Child Tax Credit will not only fail to reach children in living in poverty, but its relief for working families will likely be temporary—the Joint Committee on Taxation estimates that many families earning between $20,000 and $40,000 will actually see their tax liability increase after 2023.

5. Strips the Child Tax Credit from millions of children with immigrant parents: The tax bill would require at least one immigrant parent to have a Social Security Number to claim the refundable portion (the first $1000) of the Child Tax Credit. Currently, immigrant parents who file their taxes with an Individual Taxpayer Identification Number (ITIN) can claim the CTC on behalf of qualifying children. This provision targets the 5 million children in mixed-status families—many of whom are among the Child Tax Credit’s most economically vulnerable recipients, according to the Center for Law and Social Policy.

How it hurts kids: Over 5 million children, 80 percent of whom are US citizens, and many of whom are economically vulnerable, would lose the Child Tax Credit.

6. Removes the Personal Exemption: The current tax code allows families a tax exemption of $4,050 per person. For some families, the loss of the personal exemption is recovered through the tax bill’s increase of the standard deduction to $18,300 for head of household filers and $24,000 for married joint filers. However, because under current law the standar deduction and personal excemption can be combined, under the new code, single parents with two or more children and married couples with one or more child could see their taxable income increase before applying other deductions, especially once the additional family credit expires.

How it hurts kids: Removing the personal exemption penalizes families with children, whether they are single or married, especially once other family credits expire.

7. Repeals Most of the State and Local Tax (SALT) Deduction: The Tax Bill ends the federal deduction for state and local income and sales taxes and limits the deduction for state and local property taxes to taxes under $10,000. According to the Government Finance Officers Association, the loss of this deduction would likely force states to lower their tax rates to reduce the additional tax burden it would place on residents.

How it hurts kids: Lower state and local taxes would make it harder for states — many of which already face serious budget strains — to raise sufficient revenues in the coming years to invest in K-12 education and child welfare services, both of which rely heavily on state and local funding.

8. Repeals the Educator Expense Deduction: Teachers, who already earn meager salaries, spend hundreds of dollars of their own money each year on classroom supplies to compensate for limited school budgets. The tax bill repeals a current provision that allows them to deduct up to $250 of this spending.

How it hurts kids: Teachers will essentially have fewer dollars to purchase school supplies—meaning children may have less access to the resources they need for a high-quality education.

9. Consolidates Educational Savings Accounts: The tax bill proposes to end Coverdell Education Savings Accounts — income restricted tax-free accounts that allow families to set aside up to $2,000 to cover K-12 costs. At the same time, the bill would expand 529 college savings accounts (which are open to everyone) to cover K-12 expenses of up to $10,000 per year at public, private and religious schools.

How it hurts kids: Ending Coverdell accounts while expanding 529’s to include K-12 tuition would effectively incentivize wealthy Americans to put away money for private school—further limiting the resources available to public schools.

10. Repeals Student Loan interest Deduction: The GOP plan would no longer allow people repaying federal and private student loans to reduce their tax burden by up to $2,500. Because the current deduction is “above-the-line,” it primarily benefits low-income families who do not itemize deductions on their tax returns and students with higher loan balances.

How it hurts kids: The repeal of student loan deductions would make higher education less affordable for low-income students, as well as foster-youth who often have to take out private student loans to pay for college.

11. Repeals other Tax Breaks for Higher Education: The tax plan would also repeal two higher education credits—the Lifetime Learning Credit and the Hope Scholarship Credit. The Lifetime Learning Credit is a flexible credit of up to $2,000 for the first $10,000 spent on education expenses. The bill would preserve the American Opportunity Tax Credit, which is worth up to $2,500 per year, and partially extends it into a fifth year. The changes are projected to reduce tuition assistance by $17.5 billion over ten years, directly impacting the ability of families to defray the costs associated with higher education.

How it hurts kids: According to former undersecretary of education Ted Mitchell, the repeal of these credits would discourage participation in postsecondary education, while making it more expensive for those who do enroll. 

12. Eliminates the Dependent Care Assistance Program (DCAP): The tax bill eliminates DCAP, an employer-sponsored provision by which working parents can put up to $5,000 (or $2,500 for single parents) of pre-tax money in a flexible savings account (FSA) to count towards annual child care costs, including the cost of a nanny, babysitter, day-care center or preschool, as well as before and after school care.

How it hurts kids: While DCAP can (and should) be strengthened, its repeal will only further limit the options available to working parents struggling to afford the skyrocketing costs of high-quality care for their children.

13. Eliminates the Employer-Provided Child Care Credit: The bill also repeals a nonrefundable credit that employers may claim up to $150,000 or 25 percent expenses related to providing or contracting to provide child care for employees, as well as 10 percent of expenses related to child care resource and referral services for their employees.

How it hurts kids: Repealing the credit is a disincentive for businesses to invest in the process of making childcare affordable and accessible to employees, limiting the options available to working parents struggling to afford high-quality care for their children.

14. Eliminates Extraordinary Medical Expense Deduction: Under the bill, families will no longer be able to deduct medical expenses that exceed ten percent of their income. Half of the households who claim the medical expense deduction earn $50,000 or less a year. The deduction applies to a wide range of medical expenses not covered by insurance, including remedial reading lessons for a dyslexic child, travel expenses to visit a child in rehabilitation, therapies of various kinds, prosthetics, high-cost drugs, and even home improvements that make the residence more accessible.

How it hurts kids: The Center for American Progress highlights that this deduction is critical for middle-class and low-income families with special needs and/or chronically ill children, who could now lose access to the full range of care they require.

15. Repeals the “Orphan Drug” Tax Credit (ODTC): The ODTC allows drug manufacturers to claim a tax credit of 50 percent of the qualified costs of clinical research and drug testing of orphan drugs, which treat rare diseases. The National Organization for Rare Disorders claims its repeal could lead to a 33 percent decrease in the development of life-saving treatments.

How it hurts kids: Even though children comprise only 23 percent of the US population, they represent 50 percent of the Americans suffering from the rare diseases that “orphan drugs” treat, and The American Academy of Pediatrics argues that this credit has spurred the development of drugs specifically targeting children with rare diseases in the past decade—meaning kids with rare diseases will suffer disproportionately from its repeal.

The Bottom Line: This Tax Code Overhaul Doesn’t Invest in Children

While not definitive, the above list is an important reminder that the bill that just passed the House—with support from 227 lawmakers—does much more than cut tax rates. Provisions that appear to benefit families in isolation aren’t happening in a vacuum, and thus could have long-lasting consequences. Meanwhile, many of the choices made in the name of “simplification” will be a direct hit on important supports for children and families in the tax code. Altogether, this long list of provisions suggests that families are not the priority in the House’s tax overhaul.

EDITOR’S NOTE: This was originally published on Medium.

In the midst of the chaos that is Washington, D.C., Congress is gambling with the health and well-being of nearly 9 million children, as funding for the Children’s Health Insurance Program (CHIP) is set to expire on September 30th.

It is not like congressional leadership didn’t know this was coming. Two years ago, over 1,500 groups urged Congress to extend CHIP for through 2019, but in its infinite wisdom, House leadership chose to only extend CHIP for two years and set the date for funding to expire just days from now. In other words, this September 30th deadline was self-imposed, and yet, both the House and Senate are on a path to fail to extend CHIP funding in a timely manner. (In sharp contrast, can you imagine, a scenario where Congress would allow funding for the entire Medicare program to expire in this manner?).

Fortunately, there is some potential for action, as Senate Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) have introduced a bipartisan agreement, S. 1827, the “Keep Kids’ Insurance Dependable and Secure Act of 2017” or the “KIDS Act of 2017.” This legislation, which would extend CHIP’s authorization and funding for five years, is strongly supported by the children’s advocacy community and the National Governors’ Association (NGA) and deserves immediate action.

First, we know that CHIP is wildly successful. At its inception in 1997, 15 percent of our nation’s children lacked health insurance coverage. To address this crisis, Republicans and Democrats, under the leadership of Sens. Hatch, Edward Kennedy (D-MA), John Chafee (R-RI), and Jay Rockefeller (D-WV), came together to forge the initial bipartisan compromise to create CHIP. Although the program began slowly, over the past 20 years, CHIP has played a critically important role in improving health care coverage for our nation’s children.

In fact, in its evaluation of the program, Mathematica Policy Research found that children in CHIP had much better access to care, fewer unmet needs, and greater financial protection than children who were uninsured.

Sen. Hatch once said that he and Sen. Kennedy believe that CHIP would “go down in history as one of the great bills.” We agree.

According to the U.S. Census Bureau, the uninsured rate for children has dropped below 5 percent. Although this remains a little known fact, CHIP, in partnership with Medicaid, has cut the uninsured rate of children by more than two-thirds in the last two decades. That is a resounding public policy success story.

This is why children’s advocates, including First Focus Campaign for Children, the American Academy of Pediatrics, the Children’s Hospital Association, the March of Dimes, the Children’s Defense Fund, Family Voices, the Children’s Dental Health Project, the Little Lobbyists, and over 1,200 other groupsstrongly support the legislation’s five-year extension of CHIP.

Second, CHIP is wildly popular with the American people. CHIP is, by definition, child-focused and families value having an insurance option for children that is specifically designed with kids in mind. Just as Medicare was designed to meet the specific needs of senior citizens, CHIP’s coverage is organized around a network of doctors, nurses, and hospitals who specialize in pediatric medicine. This ensures that children in need of eyeglasses or vaccines or who have an array of conditions, such as childhood cancer, asthma, spina bifida, or sickle cell anemia, will be treated by an appropriate health care professional.

Consequently, in a 2014 Satisfaction Survey of Iowa parents whose children were enrolled in “hawk-i“ (Iowa’s CHIP program), an overwhelming 93.7 percent expressed satisfaction with the care received and less than one percent (or 0.7 percent) expressed dissatisfaction with the care their children received. There are no insurance products that engender that high level of support — not even close.

Thus, it is not surprising that, in a survey of voters by American Viewpoint, a Republican polling firm, support for extending CHIP was 74–14 percent. Support is strong and overwhelming among every group. Even Tea Party supporters favored extending the program by a 66–18% margin.

In sharp contrast, the most recent Gallup poll finds that just 16 percent of Americans approve of the work that Congress is doing. If you were that unpopular with your boss, which for Congress is the American people, wouldn’t that inspire you to do what they want, which is to extend CHIP and not put the health coverage of 9 million children at risk?

Third, there is a great sense of urgency for anyone working closely with CHIP to get this done as soon as possible. For example, if Congress fails to extend CHIP funding prior to the end of the month, states will be forced to put in motion a variety of administrative actions, which are costly, to prepare to wind down the program, which includes sending out millions of disenrollment notices to families. According to the National Academy of State Health Policy (NASHP), which represents the CHIP directors:

. . .if Congress doesn’t extend federal funding soon, states will need to initiate contingency plans and there are costs associated with making programmatic changes. States assumed federal funding would continue for CHIP, so there are no funds allocated in state budgets to shut down their CHIP programs. As a result, states will need to use their remaining federal CHIP funds to help absorb those costs. It is hard to calculate exactly what those costs will be, but states will need to:

• Invest staff time and financial resources to develop communication plans, including notices to the public about program changes;
• Train call center staff to communicate with families;
• Review and in some cases terminate or change contracts with third party administrators or health plans;
• Make enrollment and eligibility systems changes, which are very costly;
• Develop a transition process, which may include starting with an enrollment freeze or disenrollment and transferring accounts to the Exchange;
• Submit waivers or state plan amendments to CMS; and
• Review and change state law and regulations.
• States will also need to reserve a portion of their current CHIP funding to cover claims from fee-for-service medical providers as they have months (in some states up to a year) to file their claims after service is rendered. The amount of funds a state will need to withhold for future claims varies depending upon their service delivery structure, but it is a factor many states will need to consider.

These unnecessary bureaucratic expenses will take away money out of CHIP that would otherwise be used to provide health coverage to children. This is not only tragic for children, but it is also an unnecessary waste of taxpayer dollars that Congress could easily prevent to extending the program on a timely basis.

There is also immediate urgency for a number of states, which will be immediately harmed by Congress’s failure to act. One example is a provision in CHIP that corrected a problem for 11 states that were unfairly penalized with a lower federal matching rate simply because they were trendsetters and had expanded coverage to children through Medicaid prior to the enactment of CHIP in 1997. Under the “qualifying states” provision, the states of Connecticut, Hawaii, Maryland, Minnesota, New Hampshire, New Mexico, Rhode Island, Tennessee, Vermont, Washington, and Wisconsin are allowed to use CHIP funding to pay the difference between the regular Medicaid matching rate and the enhanced CHIP matching rate for those expansion kids. Those states lose that assistance on October 1st if Congress fails to pass S. 1827.

Consequently, in a letter to Minnesota’s congressional delegation, Emily Piper, Commissioner for Minnesota’s Department of Human Services, strongly urges them to extend CHIP funding prior to the end of the month and outlines a number of problems that children and pregnant women in her State will face if Congress fails to take action that include the loss of the “qualifying states” funding. She also points out that the state will have to take a number of complicated steps in order to ensure that the prenatal and postpartum care of pregnant women “continues uninterrupted” as of October 1st and that it is something the State is “exploring” but explains such a fix “comes with a significant financial penalty” to Minnesota. Again, this could be resolved if Congress would act before its self-imposed deadline.

Another example is the language related to Express Lane Eligibility (ELE) expires at the end of the month. ELE gives states the ability to streamline bureaucracy and simplify applications for eligibility determinations and renewals. As the Department of Health and Human Services (HHS) explains, “Express Lane Eligibility permits States to rely on findings, for things like income, household size, or other factors of eligibility from another program. . .to facilitate enrollment in health coverage.”

Under current law, this allows families from having to prove to states — often the same state agency — what their income, residence, and family size are again and again and again in order to qualify for services. However, if this provision expires, the states of Alabama, Colorado, Iowa, Louisiana, Maryland, Massachusetts, New Jersey, Oregon, Pennsylvania, South Carolina, South Dakota, and Utah may have to seek waivers or otherwise be required to change their eligibility systems and reestablish certain bureaucratic functions at administrative considerable costs that burden families and decrease health coverage for children.

Unfortunately, some members of Congress fail to understand that there is any sense of urgency because that projections of when CHIP dollars are exhausted may not be for several months from now. However, these projections are nothing more than estimates. As NASHP explains:

Most importantly, the projections [of carry-over funding] are made using data from previous months’ expenditures, which is the best information states have. But they are just projections. There are factors that could result in states spending more for their CHIP programs in the coming months that are not captured in the current projections.

For example, the states of Texas, Louisiana, Florida, and Georgia have all been greatly impacted by Hurricanes Harvey and Irma in the last few weeks. Therefore, it is highly likely that any previous projection of when their state CHIP dollars would run out are undoubtedly way off now.

While Congress continues to explore ways that they may either modify or repeal the Affordable Care Act (ACA) or Obamacare, if CHIP funding is not extended, the states will have no choice but to explore ways to begin trying to move children into Obamacare, which is both costly and rather ironic, since a Republican-led Congress would cause that to happen. As NASHP points out:

During a recent conference call with representatives from state CHIP and Medicaid programs, several officials expressed serious concerns that CHIP funding had not yet been extended. Given the ongoing uncertainty, they are beginning to coordinate with health insurance Exchange officials to develop transition plans. They are seriously considering the policy and systems changes required to seamlessly transition children currently covered by CHIP that may be eligible for the ACA tax credits into qualified health plans (QHPs).

The systems are currently designed to ensure that children eligible for CHIP are enrolled in that program and not in a QHP. If CHIP ends and children need to be transitioned to other potential sources of coverage, there are layers of decision points embedded in state and federal eligibility systems that support enrollment in CHIP that would need to be redirected to ensure a child does not get stuck pinging between the Exchange and a CHIP program that is in in the process of being shut down. Identifying and implementing the necessary changes and testing the updated systems will require time and substantial funding that states, which are expected to exhaust their CHIP funding by early 2018, do not have.

These things should never happen and Congress could easily alleviate such problems. Doing so would be logical, prudent, popular, and really, a no-brainer.

Investing in our children’s health is investing in America’s future. When we help our children develop and thrive, we are paving the way for our country’s next generation of workers and leaders to succeed. It’s well past time that we made kids a national priority the same way parents make them a family priority. Children should no longer be treated as an afterthought by our congressional representatives.

Former Senate Majority Leader Bill Frist (R-TN) recently called upon the Congress to extend CHIP. As he wrote in Forbes:

CHIP is what a successful, effective government program looks like. Historically, Democrats and Republicans have not hesitated to preserve and strengthen it. They should do so again now.

Frist adds:

I do not ask Congress to reauthorize this program for the sake of protecting a political legacy, mine or otherwise. Nor do I call on them to do so for the sake of bipartisanship, though our country would certainly benefit from it.

Instead, I urge them to reauthorize this program for the sake of the next generation — a generation that can make our economy stronger, keep our country safer, and forge an even greater, broader, more robust version of the American Dream.

For, if we insure our children, we ensure our future.

We strongly agree and ask for your help by calling your two senators and congressional representative to urge them to support S. 1827, the “KIDS Act of 2017” and push for its immediate passage. The health and well-being of nearly 9 million children are at stake.

In the midst of the chaos that is Washington, D.C., Congress is gambling with the health and well-being of nearly 9 million children, as funding for the Children’s Health Insurance Program (CHIP) is set to expire on September 30th.

It is not like congressional leadership didn’t know this was coming. Two years ago, over 1,500 groups urged Congress to extend CHIP for through 2019, but in its infinite wisdom, House leadership chose to only extend CHIP for two years and set the date for funding to expire just days from now. In other words, this September 30th deadline was self-imposed, and yet, both the House and Senate are on a path to fail to extend CHIP funding in a timely manner. (In sharp contrast, can you imagine, a scenario where Congress would allow funding for the entire Medicare program to expire in this manner?).

Fortunately, there is some potential for action, as Senate Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) have introduced a bipartisan agreement, S. 1827, the “Keep Kids’ Insurance Dependable and Secure Act of 2017” or the “KIDS Act of 2017.” This legislation, which would extend CHIP’s authorization and funding for five years, is strongly supported by the children’s advocacy community and the National Governors’ Association (NGA) and deserves immediate action.

First, we know that CHIP is wildly successful. At its inception in 1997, 15 percent of our nation’s children lacked health insurance coverage. To address this crisis, Republicans and Democrats, under the leadership of Sens. Hatch, Edward Kennedy (D-MA), John Chafee (R-RI), and Jay Rockefeller (D-WV), came together to forge the initial bipartisan compromise to create CHIP. Although the program began slowly, over the past 20 years, CHIP has played a critically important role in improving health care coverage for our nation’s children.

In fact, in its evaluation of the program, Mathematica Policy Research found that children in CHIP had much better access to care, fewer unmet needs, and greater financial protection than children who were uninsured.

 Sen. Hatch once said that he and Sen. Kennedy believe that CHIP would “go down in history as one of the great bills.” We agree.

According to the U.S. Census Bureau, the uninsured rate for children has dropped below 5 percent. Although this remains a little known fact, CHIP, in partnership with Medicaid, has cut the uninsured rate of children by more than two-thirds in the last two decades. That is a resounding public policy success story.

This is why children’s advocates, including First Focus Campaign for Children, the American Academy of Pediatrics, the Children’s Hospital Association, the March of Dimes, the Children’s Defense Fund, Family Voices, the Children’s Dental Health Project, the Little Lobbyists, and over 1,200 other groupsstrongly support the legislation’s five-year extension of CHIP.

Second, CHIP is wildly popular with the American people. CHIP is, by definition, child-focused and families value having an insurance option for children that is specifically designed with kids in mind. Just as Medicare was designed to meet the specific needs of senior citizens, CHIP’s coverage is organized around a network of doctors, nurses, and hospitals who specialize in pediatric medicine. This ensures that children in need of eyeglasses or vaccines or who have an array of conditions, such as childhood cancer, asthma, spina bifida, or sickle cell anemia, will be treated by an appropriate health care professional.

Consequently, in a 2014 Satisfaction Survey of Iowa parents whose children were enrolled in “hawk-i“ (Iowa’s CHIP program), an overwhelming 93.7 percent expressed satisfaction with the care received and less than one percent (or 0.7 percent) expressed dissatisfaction with the care their children received. There are no insurance products that engender that high level of support — not even close.

Thus, it is not surprising that, in a survey of voters by American Viewpoint, a Republican polling firm, support for extending CHIP was 74–14 percent. Support is strong and overwhelming among every group. Even Tea Party supporters favored extending the program by a 66–18% margin.

In sharp contrast, the most recent Gallup poll finds that just 16 percent of Americans approve of the work that Congress is doing. If you were that unpopular with your boss, which for Congress is the American people, wouldn’t that inspire you to do what they want, which is to extend CHIP and not put the health coverage of 9 million children at risk?

Third, there is a great sense of urgency for anyone working closely with CHIP to get this done as soon as possible. For example, if Congress fails to extend CHIP funding prior to the end of the month, states will be forced to put in motion a variety of administrative actions, which are costly, to prepare to wind down the program, which includes sending out millions of disenrollment notices to families. According to the National Academy of State Health Policy (NASHP), which represents the CHIP directors:

. . .if Congress doesn’t extend federal funding soon, states will need to initiate contingency plans and there are costs associated with making programmatic changes. States assumed federal funding would continue for CHIP, so there are no funds allocated in state budgets to shut down their CHIP programs. As a result, states will need to use their remaining federal CHIP funds to help absorb those costs. It is hard to calculate exactly what those costs will be, but states will need to:

· Invest staff time and financial resources to develop communication plans, including notices to the public about program changes;

· Train call center staff to communicate with families;

· Review and in some cases terminate or change contracts with third party administrators or health plans;

· Make enrollment and eligibility systems changes, which are very costly;

· Develop a transition process, which may include starting with an enrollment freeze or disenrollment and transferring accounts to the Exchange;

· Submit waivers or state plan amendments to CMS; and

· Review and change state law and regulations.

States will also need to reserve a portion of their current CHIP funding to cover claims from fee-for-service medical providers as they have months (in some states up to a year) to file their claims after service is rendered. The amount of funds a state will need to withhold for future claims varies depending upon their service delivery structure, but it is a factor many states will need to consider.

These unnecessary bureaucratic expenses will take away money out of CHIP that would otherwise be used to provide health coverage to children. This is not only tragic for children, but it is also an unnecessary waste of taxpayer dollars that Congress could easily prevent to extending the program on a timely basis.

There is also immediate urgency for a number of states, which will be immediately harmed by Congress’s failure to act. One example is a provision in CHIP that corrected a problem for 11 states that were unfairly penalized with a lower federal matching rate simply because they were trendsetters and had expanded coverage to children through Medicaid prior to the enactment of CHIP in 1997. Under the “qualifying states” provision, the states of Connecticut, Hawaii, Maryland, Minnesota, New Hampshire, New Mexico, Rhode Island, Tennessee, Vermont, Washington, and Wisconsin are allowed to use CHIP funding to pay the difference between the regular Medicaid matching rate and the enhanced CHIP matching rate for those expansion kids. Those states lose that assistance on October 1st if Congress fails to pass S. 1827.

Consequently, in a letter to Minnesota’s congressional delegation, Emily Piper, Commissioner for Minnesota’s Department of Human Services, strongly urges them to extend CHIP funding prior to the end of the month and outlines a number of problems that children and pregnant women in her State will face if Congress fails to take action that include the loss of the “qualifying states” funding. She also points out that the state will have to take a number of complicated steps in order to ensure that the prenatal and postpartum care of pregnant women “continues uninterrupted” as of October 1st and that it is something the State is “exploring” but explains such a fix “comes with a significant financial penalty” to Minnesota. Again, this could be resolved if Congress would act before its self-imposed deadline.

Another example is the language related to Express Lane Eligibility (ELE) expires at the end of the month. ELE gives states the ability to streamline bureaucracy and simplify applications for eligibility determinations and renewals. As the Department of Health and Human Services (HHS) explains, “Express Lane Eligibility permits States to rely on findings, for things like income, household size, or other factors of eligibility from another program. . .to facilitate enrollment in health coverage.”

Under current law, this allows families from having to prove to states — often the same state agency — what their income, residence, and family size are again and again and again in order to qualify for services. However, if this provision expires, the states of Alabama, Colorado, Iowa, Louisiana, Maryland, Massachusetts, New Jersey, Oregon, Pennsylvania, South Carolina, South Dakota, and Utah may have to seek waivers or otherwise be required to change their eligibility systems and reestablish certain bureaucratic functions at administrative considerable costs that burden families and decrease health coverage for children.

Unfortunately, some members of Congress fail to understand that there is any sense of urgency because that projections of when CHIP dollars are exhausted may not be for several months from now. However, these projections are nothing more than estimates. As NASHP explains:

Most importantly, the projections [of carry-over funding] are made using data from previous months’ expenditures, which is the best information states have. But they are just projections. There are factors that could result in states spending more for their CHIP programs in the coming months that are not captured in the current projections.

For example, the states of Texas, Louisiana, Florida, and Georgia have all been greatly impacted by Hurricanes Harvey and Irma in the last few weeks. Therefore, it is highly likely that any previous projection of when their state CHIP dollars would run out are undoubtedly way off now.

While Congress continues to explore ways that they may either modify or repeal the Affordable Care Act (ACA) or Obamacare, if CHIP funding is not extended, the states will have no choice but to explore ways to begin trying to move children into Obamacare, which is both costly and rather ironic, since a Republican-led Congress would cause that to happen. As NASHP points out:

During a recent conference call with representatives from state CHIP and Medicaid programs, several officials expressed serious concerns that CHIP funding had not yet been extended. Given the ongoing uncertainty, they are beginning to coordinate with health insurance Exchange officials to develop transition plans. They are seriously considering the policy and systems changes required to seamlessly transition children currently covered by CHIP that may be eligible for the ACA tax credits into qualified health plans (QHPs).

The systems are currently designed to ensure that children eligible for CHIP are enrolled in that program and not in a QHP. If CHIP ends and children need to be transitioned to other potential sources of coverage, there are layers of decision points embedded in state and federal eligibility systems that support enrollment in CHIP that would need to be redirected to ensure a child does not get stuck pinging between the Exchange and a CHIP program that is in in the process of being shut down. Identifying and implementing the necessary changes and testing the updated systems will require time and substantial funding that states, which are expected to exhaust their CHIP funding by early 2018, do not have.

These things should never happen and Congress could easily alleviate such problems. Doing so would be logical, prudent, popular, and really, a no-brainer.

Investing in our children’s health is investing in America’s future. When we help our children develop and thrive, we are paving the way for our country’s next generation of workers and leaders to succeed. It’s well past time that we made kids a national priority the same way parents make them a family priority. Children should no longer be treated as an afterthought by our congressional representatives.

Former Senate Majority Leader Bill Frist (R-TN) recently called upon the Congress to extend CHIP. As he wrote in Forbes:

CHIP is what a successful, effective government program looks like. Historically, Democrats and Republicans have not hesitated to preserve and strengthen it. They should do so again now.

Frist adds:

I do not ask Congress to reauthorize this program for the sake of protecting a political legacy, mine or otherwise. Nor do I call on them to do so for the sake of bipartisanship, though our country would certainly benefit from it.

Instead, I urge them to reauthorize this program for the sake of the next generation — a generation that can make our economy stronger, keep our country safer, and forge an even greater, broader, more robust version of the American Dream.

For, if we insure our children, we ensure our future.

We strongly agree and ask for your help by calling your two senators and congressional representative to urge them to support S. 1827, the “KIDS Act of 2017” and push for its immediate passage. The health and well-being of nearly 9 million children are at stake.

The Welfare Reform and Upward Mobility Act, introduced in June by House Freedom Caucus Chair Rep. Mark Meadows, Freedom Caucus member Rep. Jim Jordan, and Senators Ted Cruz and Mike Lee, would impose harsh new requirements on recipients of on anti-poverty programs such as the Supplemental Nutrition Assistance (SNAP) program and the Temporary Assistance for Needy Families (TANF) program, as well as reduce funding for federal housing assistance through transforming it into a block grant.

These new requirements would be impossible for many program participants to meet, resulting in millions of households with children losing access to nutrition, cash and housing assistance. It would require states to mandate strict work requirements for SNAP and TANF participants without any funding for child care or job training to help parents meet these requirements. And by transforming housing assistance into a block grant, funds would remain fixed at the 2016 funding level and would result in a $35 billion loss of funds by 2028.

SNAP is one of the most powerful anti-poverty programs we have. It is particularly effective because it can be responsive during times of economic downturns, helping families bridge times of temporary financial hardship. Nearly half of every SNAP dollar goes to children and SNAP is credited with reducing food insecurity among children by 33 percent after their families had been receiving SNAP benefits for about six months. SNAP is also credited with boosting academic performance in kids and laying a foundation for economic self-sufficiency.

Children make up over 70 percent of TANF recipients, but despite an increasing number of research findings on the importance of cash assistance for child development, very few families currently receive cash assistance. When TANF started in 1996, 68 percent of families in poverty received assistance, however, by 2010 that number dropped to just 27 percent, and caseloads have continued to drop even though need has not decreased.

First Focus’s 2016 Children’s Budget Book found that nearly a quarter of tenant-based rental assistance funding goes to children. Access to housing assistance remains extremely limited - only one in four families who are eligible for rental assistance in the U.S. receive it. By replacing these programs with block grants, as the bill proposes, would limit access to housing assistance even further and eliminate subsidies for 2.6 million low-income households.

Child poverty remains stubbornly high in the U.S. and would be a lot higher without these critical programs. These programs lift millions of children out of poverty each year – SNAP, TANF and housing subsidies collectively lifted more than two million children out of poverty in 2015.

By making it harder for parents and guardians to meet the requirements for these programs, children lose out. The child poverty rate would rise, resulting in potentially millions of children experiencing increased food insecurity, housing instability, toxic stress and other consequences that all negatively affect healthy child development and academic achievement. Many parents of households receiving SNAP and TANF already work, but don’t make enough to make ends meet without critical assistance.

This legislation is the wrong direction to combat child poverty in the U.S. Instead, we need to further invest in effective anti-poverty programs and build on what works.

This includes establishing a universal child allowance, which would ensure that every child in the U.S. lives in a household with an income sufficient to meet their basic needs and support their healthy development. This amount should be large enough to ensure that every child is lifted out of poverty and is not subject to the whim of economic downturns or parental labor participation. All other Anglo-American countries (Canada, UK, Ireland, Australia) provide some form of universal child or family benefit, and all have lower child poverty rates than the U.S.

For additional resources on reducing child poverty:

The Child Poverty Reduction Act (S. 1630/H.R. 3381)

The U.S. Child Poverty Action Group

First Focus comments for the National Academy of Sciences Committee on Building an Agenda to Reduce the Number of Children in Poverty by Half in 10 Years

Make TANF Work for Children

Learning to drive is a rite of passage to young adulthood for millions of youth. It brings new levels of independence and opportunities, enabling young people to take themselves to school, work, and extra-curricular activities. Studies have shown that kids with access to a car do better in school, get better jobs, have more college options, and have more successful careers.

Teens in foster care often face significant barriers to obtaining a driver’s license. Some of these barriers include difficulty securing the parental or guardian permission needed to enroll in driver’s education or to secure an insurance policy, as well as an inability to pay for the various fees associated with becoming a driver. Without a driver’s license, young people in foster care often miss out on age-appropriate opportunities that contribute to success in adulthood.

The Foster Youth Driving Act introduced by US Rep. Danny Davis (IL-7) provides prospective foster parents with training to help prepare a young person to drive. It also provides funds to assist with this process such as assistance with vehicle insurance costs, driver’s education class and testing fees, and fees related to obtaining a driver’s license. Reducing these barriers will increase the sense of normalcy for foster youth and empower them to seek opportunities of higher education and gainful employment.

Several states have also passed legislation related to reducing these barriers for foster youth. Florida’s ground breaking program Keys to Independence, which works to reduce the barriers for foster youth in gaining driving experience and getting a license, was granted permanency this year.  Arizona passed a bill that allows foster youth to purchase car insurance. Most recently Kentucky and South Carolina passed similar legislation that extends authorization for who can sign off for a learner’s permit and driver’s license.

Obtaining a driver’s license can play a significant role in the life of an adolescent or young adult in foster care. SPARC, an initiative of First Focus, has launched a campaign called Going Places. The campaign is dedicated to improving state policies regarding foster youth and their access to driver's licenses, driver’s education, practice hours, access to cars, and insurance.

• To read the letter of support, click here.
• Learn more about the Going Places campaign.

Raising five children, Rep. Markwayne Mullin (R-OK) undoubtedly knows a thing or two about the health care needs of children. In a Today storyrelated to Father’s Day last year that highlighted the decision of the Congressman and his wife to adopt two children after having three of their own, he shared a picture of himself at the hospital with his son, who had suffered a broken wrist. It is clearly the picture of a caring, loving father who would never intentionally put the health of his children at risk.

In a blog entitled “Leaving a Healthy Legacy” that the Congressman wrote last week highlighting Men’s Health Month, he says:

My kids are smaller versions of myself, so teaching them how to be healthy and giving them access to the tools and resources they need to maintain a healthy lifestyle is vital to their growth and development in adulthood.

This month, I encourage you to make a commitment to your own health. Let’s leave a healthy legacy for the next generations of Oklahomans.

In March 2015, Rep. Mullin helped “leave a healthy legacy” when he voted in favor of a bill, the Medicare Access and CHIP Reauthorization Act of 2015, which fixed a problem with the Medicare physician payment formula to address access to care concerns for senior citizens but also extended funding for the Children’s Health Insurance Program (CHIP) for two years. Child advocates from across the country were supportive of the extension of CHIP, even though the two-year extension was shorter than the four years they were seeking.

Mullin also recently expresses great concern about another health policy issue: potential budget cuts that would be “detrimental” to providers in the Medicaid program due to Oklahoma’s difficult budget situation. As he explains in a Tulsa World Op-Ed on May 27, 2016:

This year, falling oil prices and other factors led to state legislators facing a $1.3 billion budget shortfall going into 2017. To make up for the shortfall, the Oklahoma Health Care Authority prepared Oklahoma Medicaid providers for the possibility of a 25 percent rate cut. It doesn’t take a health care expert to understand that a rate cut of this magnitude would be detrimental to Oklahoma’s health care providers.

Luckily, our state Legislature worked to develop a state budget that only cuts Medicaid rates by 3 percent, and while a 3 percent cut will still impact our nursing homes and hospitals, it is not the disaster it could have been.

We would agree with him that enormous cuts to Medicaid would have been devastating to providers. However, we would add that such cuts would have been harmful to hundreds of thousands of people the program, known as SoonerCare, provides coverage to in Oklahoma. According to Oklahoma Watch, nearly two-thirds of those covered by SoonerCare are children.

However, the Congressman clearly distinguishes Medicaid and CHIP from the Accordable Care Act (ACA) or Obamacare, which he has repeatedly voted to repeal. In a Tulsa World Op-Ed, he explained, “All in all, I have supported more than 50 different efforts to either fully repeal or chip away at ‘Obamacare’ since my time representing your family in Congress.”

Although we agree changes need to be made to the ACA, including major revisions to the “family glitch”, the “Cadillac tax”, or other improvements outlined by Georgetown’s Center for Children and Families, we oppose repeal of the law because it would dramatically increase the number of uninsured children and create a number of other negative consequences for America’s children.

In short, when it comes to public policy issues, Rep. Mullin has clearly voted for or expressed interest in: (1) support for CHIP and children’s health coverage; (2) opposition to Medicaid cuts that would create negative consequences for Oklahoma’s health care providers; (3) opposition to Obamacare; and, (4) concern about the Oklahoma’s state budget deficit.

What is surprising, then, is that a recent vote and a bill introduction by Rep. Mullin would have, paradoxically, either the opposite results or unintended negative consequences to those four policy positions.

First, Rep. Mullin, as a member of the House Energy and Commerce Committee, voted in favor of H.R. 4725, the “Common Sense Savings Act of 2016,” which would rollback the Enhanced Federal Matching Assistance Program (E-FMAP) in CHIP by 23 percentage points effective March 16, 2016. For Oklahoma, their federal matching rate this year is 95.69 percent and that legislation would have decreased the federal share to 72.69 percent. From the State’s perspective, if that legislation had been enacted, it would have increased the state share for CHIP in the middle of the fiscal year by 534 percent.

That change would have increased Oklahoma’s budget shortfall this year, and consequently, it could have resulted in harm to both the providers and children enrolled in SoonerCare.

Although there is some rationale for considering changes to the matching rate in the future, particularly with respect to the match associated with administrative costs as those costs probably should be more evenly shared, making such a change in the middle of this fiscal year would be detrimental to three concerns that Rep. Mullin had previously asserted: concerns about Oklahoma’s budget deficit, impact on health care providers, and the health of children.

Second, and far more concerning and potentially harmful to children is a provision in the bill, the “Preserving Access to Medicaid for Americans (PAMA) Act of 2016” (H.R. 5375) that was introduced by Rep. Mullin on May 27, 2016. While the bill’s title includes the words “Preserving Access,” paradoxically, the legislation does the exact opposite when it comes to protecting the health coverage of over 8 million of our nation’s children enrolled in CHIP by eliminating the law’s “Maintenance of Effort” (MOE) requirement.

The MOE prevents states from eliminating or slashing their CHIP programs and dumping children into Obamacare, weaker private coverage, or worse, into the ranks of the uninsured. If the MOE were to be eliminated, children in working families across the nation would lose a trustworthy, proven source of coverage and be put in harm’s way.

This type of legislative approach had been raised before in Congress by former Rep. Phillip Gingrey (R-GA) and Sen. Orrin Hatch (R-UT) in 2011. That bill, the “State Flexibility Act” was analyzed by the Congressional Budget Office (CBO), which estimated that, if the legislation had been passed five years ago, there would have been a “reduction in CHIP enrollment of about 1.7 million people.”

Similarly, with just that one sentence in Sec. 2 of Rep. Mullin’s bill, the demise of CHIP and the coverage it offers to millions of children would be placed in jeopardy. As First Focus Campaign for Children said in a letter to Congress on June 1, 2011, in opposition to the “State Flexibility Act”:

It is ironic and hopefully unintentional that that a large share of those children would be left uninsured or shifted out of CHIP and into inferior coverage in [Obamacare] insurance exchanges plans that proponents of H.R. 1683 have sought to repeal.

That same concern and objection holds true five years later. And, although some states would save money by shifting children from low-income working families into the ranks of the uninsured or into Obamacare, it be devastating to the health care for millions of children, harm providers, and lead to an expansion of Obamacare — all things that Rep. Mullin professes to oppose.

Therefore, we would urge Rep. Mullin to strike, delete, or discard Sec. 2 in PAMA. In his own words, “giving [children] access to the tools and resources they need to maintain a healthy lifestyle is vital to their growth and development in adulthood.” For 8 million children across this country, that is CHIP.

Instead of putting the health coverage of children at risk, we urge Congress and Rep. Mullin to adopt two key principles:

First, Congress should do no harm. For children enrolled in CHIP, that means protecting past progress and not enacting any policy that would make children worse off in terms of their health coverage. From vaccinations, well-child check-ups, and chronic disease management, to oral health and vision care, Medicaid and CHIP ensure that children get the services they need to grow, develop, and go to school ready to learn. It makes no sense to disrupt this successful coverage for kids.

Second, Congress must ensure that our health system continues to support care for children that meets their unique health and developmental needs, including the availability of pediatric networks of care delivery. There is a reason we have pediatricians and children’s hospitals in this country, as children are not just little adults. Medicaid and CHIP recognize that children have special and distinct needs and these programs are designed to ensure that children can get the high quality care they need and deserve.

Unfortunately, Sec. 2 in H.R. 5375, even though it is just a single sentence long, violates both principles. As highlighted by CBO in its past analysis of a similar provision, eliminating the CHIP MOE undermines coverage for children in both the short- and long-term. It removes children from CHIP coverage, which is, by definition, specifically designed for children, and causes children to either become uninsured or moved into insurance exchanges that will be far weaker than CHIP and that Rep. Mullin has voted repeatedly to eliminate.

On this last point, Republican Congressmen Charles Dent, Todd Russell Platts, Bill Shuster, Jim Gerlach, and Glenn Thompson of Pennsylvania strongly opposed the very idea of moving children out of CHIP into the insurance exchanges back in November 7, 2009, during consideration of the ACA. As the Republican congressmen wrote in a letter to then-Speaker Nancy Pelosi (D-CA):

We are writing to express our grave concerns with provisions included in H.R. 3962, the Affordable Health Care for America Act, that would eliminate the Children’s Health Insurance Program (CHIP) and require all children. . .who are not covered under a Medicaid CHIP (M-CHIP) expansion program to be moved into the new health insurance exchange.

The Pennsylvania congressmen go on to explain how CHIP has been an “overwhelming success” since its inception. They explain:

There is no better example of a public-private health partnership that has contributed to the lives of Pennsylvania families. We often hear from our constituents that their children are healthy and active because of CHIP.

They add that CHIP is “an efficient program that provides Pennsylvania children with affordable, quality care” and that moving children from CHIP into the insurance exchanges would result in “a step in the wrong direction for our nation — imposing higher costs and delivering fewer benefits to our most vulnerable population.”

Unless Rep. Mullin has had a change of heart and has decided to expand Obamacare rather than repeal it, we would urge him to take the advice of his Republican colleagues who argued that we should leave CHIP intact rather than dismantle it. As they conclude:

Protecting children, especially those most in need, should be one of Congress’s top priorities in the context of health reform.

We couldn’t agree more.

 

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