The Tri-Committee Health Reform Bill: Implications for Children

A little more than two weeks ago 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.)

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.)  

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


7 replies »

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  2. Such as Organ Transplants? If that was your loved one DYING due to a bad organ, and there was any chance that the transplant would work, your saying you would be OK with the GOVERNMENT deciding your loved one was not worth the CHANCE it might work? Are you serious? My daughter has an immune defeciency and takes costly intradermal medicines to keep her from getting sick and the rest of her immune system from shutting down. I do NOT want the government buricrates deciding whether or not she is WORTH the money!!!!!!

  3. There must be a way that the wealthiest country in the world can finance basic health care for it’s citizens. This will probably be possible by avoiding extremely costly procedures with uncertain outcomes such as organ transplants ect. Also the focus should be on prevention,such as refusing to treat the obese until they have slimmed down.

  4. Unfortunately, the barriers to enrollment that Jocelyn describes not only exist, but are used by a number of states to help “control” the cost of the program. We truly need to change the incentives of these states from their short-sighted focus on Medicaid budgets to a longer-term view that taking good care of children has a huge payback to everyone involved.

  5. According to the recent ABC News and Washington Post poll ( http://abcnews.go.com/images/PollingUnit/1091a2HealthCareReform.pdf ), only 43 percent of Americans are satisfied with “the overall health care system in the country”, including just 10 percent, who are very satisfied. 58 percent are in favor of healthcare reform as “necessary to control costs and expand coverage”. In other words, there is a general sense of dissatisfaction with the status quo. At the same time, “83 percent are very or somewhat satisfied with the quality of their care, 81 percent of insured adults are satisfied with their coverage, and 55 percent of Americans (61 percent of the insured) rate their costs positively”, which means that most Americans would hardly support changes that they may feel as negative to their personal circumstances.
    Please take a look at my blog at http://betterhc.blogspot.com/2009/07/healthcare-reform-balancing-act.html.

  6. Great article, Jocelyn! You nail it when you describe the difficulties of joining S-CHIP or Medicaid for your kids. California has done a good job with online and more streamlined enrollment. Hopefully other states will copy that.