Children’s Health Status – The Link to CHIP Legislative Deadline

Employed adults who are low-income but not poor enough for Medicaid have been able to obtain health insurance for their children under CHIP since its federal enactment in 1997. This was recognized as important to containing the spread of contagious children’s diseases, as well as maintaining public health throughout the US. According to the Kaiser Family Foundation, there were 8,900,075 children enrolled in CHIP as of 2016 (1).

Most parents receiving CHIP (Children’s Health Insurance Program) coverage for their children work in retail, restaurant, hotel, and non-union construction positions—and these are notoriously low-paying. Although CHIP is only funded through FY 2017, Congress has still not yet renewed federal funding for CHIP. As a result, the New York Times reports that millions of children are at risk of losing health insurance coverage beginning in January 2018 (2).

How CHIP Curbs US Health System Spending

Children with asthma represented 13.6 percent of all children covered by Medicaid and CHIP in 2010, and 1.2 percent of children with congenital heart disorders (per an Urban Institute report) (3). If not adequately treated, children afflicted with these conditions can become disabled or experience sudden death. A lack of medical intervention can also lead to substantial disability or premature death in adulthood. The US asthma cost-burden is around $56 billion annually, per the Centers for Disease Control (4). Meanwhile, congenital heart disorders are diagnosed in 40,000 US newborns each year (5).

The US Bureau of Labor Statistics reported that 50.2 percent of adults in the US between 25-54 years of age were not in the workforce in 2014 (6). In this same age demographic, 6 percent of men (and 5.7 percent of women) were classified as not employed due to illness/disability (7). Besides being reliant on Social Security disability (SSDI or SSI) benefits, young adults with disabilities are typically high consumers of medical services. Therefore, preventing future disability in children and adolescents with health disorders can aid in curtailing national healthcare spending.

Ethnic Disparities in Health Disorders and Hospitalization

It is widely recognized among public health researchers that African-Americans have a higher incidence of chronic health disorders and disability (e.g., diabetes and related complications). The hospital admission rate due to an asthma attack was 127.5 in African-Americans aged 18-39 years (as opposed to 39.3 in white Americans) (8).

Among Hispanics, the rate of hospital Emergency Department (ED) utilization was 13.3 (as opposed to 6.4 among white Americans). Furthermore, asthma mortality in Hispanic children is twice that of white children in the US (9).

Hispanics and Latinos in the US—especially Mexican-Americans—are disproportionately relegated to low-wage, seasonal jobs that do not provide health insurance. Furthermore, due to Attorney General Jeff Sessions’ increased prosecution of undocumented immigrants, Latino fear of harassment is already resulting in reluctance to seek ED medical care for their children. Indeed, the loss of CHIP will only prevent more Hispanic/Latino children from seeking medical interventions.

Without health insurance, parents of children with health disorders and disabilities have little recourse to acquiring physician services. The result will likely be a higher incidence of dead or permanently disabled children—especially children who are not white. In turn, poor health will lead to an even greater difficulty for these children to maintain the regular school attendance necessary to finish high school and acquire acceptance to college.

Rural-Urban Disparities in Children’s Health Insurance

Twenty percent of all youth in the US live in nonmetropolitan areas, according to a study by Georgetown University Health Policy Institute (10). This study also found that children in rural areas are less likely to receive preventive healthcare (i.e., receive information regarding a healthy diet and exercise routine).

Overall, rural populations are less likely to be insured—while also having a higher prevalence of health disorders and poverty—than urban residents (11). Consequently, it is probable that de-funding CHIP will have a particularly negative impact on rural areas.

Discrepancies in CHIP Demise Impact on States

A report of MACPAC specifies that—unless CHIP funding is renewed by Congress—all states will exhaust their CHIP funds in 2018, and the following are the four poised to first exhaust their allotted dollars (12):

  • Arizona;
  • District of Columbia;
  • Minnesota;
  • North Carolina 

Included in the 16 states projected by the Kaiser Family Foundation to run totally out of monies by the end of January 2018 are the following six (13):

  • California
  • Florida
  • Massachusetts
  • Pennsylvania
  • Texas
  • Virginia

Their study also notes that—without CHIP re-funding by Congress—the following five states plan to end CHIP coverage by January 31, 2018 (14):

  1. Colorado (74,873 individuals affected);
  2. Connecticut (17,000 individuals affected);
  3. Texas (452,179 individuals affected);
  4. Virginia (67,000 individuals affected);
  5. Utah (number of affected individuals not reported)

From Chicken Pox to Lice – How Lack of Healthcare Affects Schools

Teachers understand that a child attending school with chicken pox (or another communicable childhood disease) can quickly spread it to other elementary school students. In turn, this can wreak havoc on the classroom learning environment. The result is that the majority of children in the class can be adversely affected by a single ill child’s attendance. Therefore, de-funding CHIP can have a significant negative effect on public schools.

According to an article in Consumer Reports in 2017, only 39 percent of all schools in the US have a full-time nurse (15). This article also notes that school system budget cuts are a primary reason that this percentage is so low. Obviously, schools will be unable to fill the healthcare treatment vacuum that will be created if CHIP is de-funded. The probability is high that more classroom health emergencies will occur as a result—and a concomitant higher burden on teachers to deal with them.

Tax Cuts for the Rich and No Health Coverage for Disadvantaged Kids

President Trump’s budget this year proposed a 20 percent cut to CHIP over the next two years (16), and Congress subsequently failed to renew funding to CHIP in October of 2017 (17).

On the other hand, the Republican-dominated Congress is positioned to enact a tax reform plan that benefits millionaires, while eliminating the ACA’s individual mandate requiring health insurance—which the Congressional Budget Office (CBO) predicts would result in 16 million more uninsured people. Assuredly, some of these people would be the children formerly covered by family plans purchased in ACA-mandated exhanges.

We urgently need our federal legislators to act quickly to preserve CHIP funding, and avoid a children’s health catastrophe in 2018! Otherwise, we will pay in future as a nation for this legislative irresponsibility and self-centeredness.

References:

  1. Henry J. Kaiser Family Foundation. Total Number of Children Ever Enrolled in CHIP Annually – Timeframe: FY 2016. Webpage: https://www.kff.org/other/state-indicator/annual-chip-enrollment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

 

  1. Park Haeyoun. (December 14, 2017). Millions of Children Could Lose Health Coverage Starting Next Month. New York Times Webpage: https://www.nytimes.com/interactive/2017/12/14/us/children-at-risk-of-losing-health-care-CHIP.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news

 

  1. Coyer, Christine, and Kenney, Genevieve. (March 2013). Low-Income Working Families Fact-Sheet. The Composition of Children Enrolled in Medicaid and CHIP – A Summary. Urban Institute Webpage: https://www.urban.org/sites/default/files/publication/32681/412782-The-Composition-of-Children-Enrolled-in-Medicaid-and-CHIP-A-Summary.PDF

 

  1. Centers for Disease Control (CDC). Asthma’s Impact on the Nation: Data from the CDC National Asthma Control Program. [Publication No. CS232840]. Webpage: https://www.cdc.gov/asthma/impacts_nation/asthmafactsheet.pdf

 

  1. American Academy of Pediatrics, Congenital Heart Public Health Consortium. FAQ Fact Sheet—Long Version. Webpage: https://www.aap.org/en-us/Documents/chphc/chd_fact_sheet_long.pdf

 

  1. US Bureau of Labor Statistics. (December 2015). People who are not in the labor force: Why aren’t they working? Beyond the Numbers 4(15). Webpage: https://www.bls.gov/opub/btn/volume-4/people-who-are-not-in-the-labor-force-why-arent-they-working.htm

 

  1. US Bureau of Labor Statistics. (December 2015). People who are not in the labor force: Why aren’t they working? Beyond the Numbers 4(15). Webpage: https://www.bls.gov/opub/btn/volume-4/people-who-are-not-in-the-labor-force-why-arent-they-working.htm

 

  1. US Office of Minority Health. Asthma and African Americans. Webpage: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=15

 

  1. US Office of Minority Health. Asthma and Hispanic Americans. Webpage: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=60

 

  1. Georgetown University Health Policy Institute. (October 20, 2017). Research Update: Health Care in Rural and Urban America. Webpage: https://ccf.georgetown.edu/2017/10/20/research-update-health-care-in-rural-and-urban-america/

 

  1. Georgetown University Health Policy Institute. (October 20, 2017). Research Update: Health Care in Rural and Urban America. Webpage: https://ccf.georgetown.edu/2017/10/20/research-update-health-care-in-rural-and-urban-america/

 

  1. MACPAC. (July 2017). Issue Brief – Federal CHIP Funding: When Will States Exhaust Allotments? Webpage: https://www.macpac.gov/wp-content/uploads/2017/03/Federal-CHIP-Funding_When-Will-States-Exhaust-Allotments.pdf

 

  1. Henry J. Kaiser Family Foundation. (December 6, 2017). State Plans for CHIP as Federal CHIP Funds Run Out. Webpage: https://www.kff.org/medicaid/fact-sheet/state-plans-for-chip-as-federal-chip-funds-run-out/

 

  1. Henry J. Kaiser Family Foundation. (December 6, 2017). State Plans for CHIP as Federal CHIP Funds Run Out. Webpage: https://www.kff.org/medicaid/fact-sheet/state-plans-for-chip-as-federal-chip-funds-run-out/

 

  1. Roberts, Catherine. (August 2, 2017). What You Should Know About School Nurses. Consumer Reports Webpage: https://www.consumerreports.org/children-s-health/what-you-should-know-about-school-nurses/

 

  1. Christensen, Jen. (May 24, 2017). Trump’s Budget Cuts Children’s Health Insurance Program. CNN Health Webpage: http://www.cnn.com/2017/05/24/health/chip-health-care-cuts-trump-budget/index.html

 

  1. Hellmann, Jessie. (October 16, 2017). No progress on negotiations to fund Children’s Health Insurance Program. The Hill Webpage: http://thehill.com/policy/healthcare/355660-no-progress-on-bipartisan-negotiations-to-fund-childrens-health-insurance

 

 

Advertisements