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Tuesday Nov 07, 2017

Inaction by Congress Jeopardizes Kids' Health

Put me on the cover of Rolling Stone, uptown, down home American kids.
-- Kenny Chesney

It's time to have a conversation about the children. On Sept. 30, the Children's Health Insurance Program (CHIP) expired when Congress failed to reauthorize the program. The consequences of this expiration are slightly muted because many states have enough funding to continue providing health care to eligible children for a short time. However, that funding is drawing down and many states face the extremely difficult reality that they may be forced to rescind health care coverage from children in the near future if Congress doesn't act.

[Male physician with small child in exam room]

CHIP is not the only program in urgent need of reauthorization and funding. The Teaching Health Center Graduate Medical Education (THCGME), National Health Service Corps (NHSC), and Community Health Center (CHC) programs all face looming deadlines and funding shortfalls. Should Congress fail to act, each of these programs would disappear, negatively impacting millions of patients and thousands of physicians and medical students.

In the past 20 years, CHIP has been one of the most bipartisan health care programs. It is a shining example of bipartisan policy-making and, as a result of this sustained bipartisan support, more than 95 percent of children in the United States have health care coverage -- a truly remarkable accomplishment of public policy.

I often laugh that seemingly every member of Congress who held elected office in 1997 claims to be the originator of the program. It is that popular.

Although the program itself remains extremely popular with both parties, its reauthorization has been caught up in the complex political realities of Washington, D.C.

Last week, the House of Representatives began the necessary legislative work to ensure that more than 9 million children do not face the loss of their health care coverage and that the THC, CHC, and NHSC programs all are extended and funded for the next two years, but it wasn't easy. The challenges were not rooted in policy, rather they centered on how the legislation was financed. In an effort to secure support from the full Republican conference, the authors of the legislation chose controversial offsets, including an actualized, six-year elimination of funding for the Prevention and Wellness Fund. This provision raised concerns for many groups, including the AAFP.

In our letter to House and Senate leadership(2 page PDF), we stated: "These programs are critically important to our health care system, and are strongly supported by the AAFP. However, we are deeply concerned that the financing of the reauthorization of these programs is achieved through dramatic near-term cuts in programs that promote health and wellness for all Americans. Although not a complete elimination of the prevention and wellness fund, the severity of these cuts over the next few years would undermine many essential public health priorities. We believe that it is important to continue bipartisan negotiations to identify alternative financing as the legislative process proceeds."

On Nov. 3, the House of Representatives approved the CHAMPIONING HEALTHY KIDS Act of 2017(www.congress.gov) (CHAMPION Act) (H.R 3922) by a vote of 242 to 174. One hundred seventy-four representatives voted against the legislation. For comparison, the last time CHIP was reauthorized, the vote on passage was 392-37.

The bill now moves to the Senate. It is widely speculated that the bill will undergo revisions in the Senate, but that is not guaranteed. In September, Senate Finance Committee Chairman Orrin Hatch, R-Utah, and Ranking Member Ron Wyden, D-Ore., introduced the Keep Kids' Insurance Dependable and Secure Act of 2017(www.govtrack.us) (S. 1827).  This bill would reauthorize the CHIP program for five years, but it did not include the extension of the THC, CHC or NHSC programs. These programs will need to be added, and financing will need to be negotiated.

Financing the legislation is where the challenges exist and will continue to exist. Major changes in the financing likely would make the reauthorization package unpassable in the House.

Further complicating the situation is the calendar. There are roughly 20 legislative days remaining in 2017, and Republican leaders in the House and Senate are itching to spend a majority of the next two months working on tax reform. This means there is little room for bickering on other matters, which could result in the Senate simply approving the House passed CHAMPION Act.

I am not sure how this will play out, but I am very confident that the CHIP program; as well as the THC, CHC, and NHSC programs will be reauthorized before the end of December. It may be awkward and borderline painful, but Congress will do the right thing for the children -- just in time for the holidays.

Wonk Hard

On Nov. 1, open enrollment for health care coverage through the health insurance marketplaces -- or Obamacare -- began. Eligible individuals have until Dec. 15 to select and enroll in a health plan. The AAFP encourages all individuals to secure health care coverage that is appropriate for them and their families. Individuals can use the extensive resources available at HealthCare.Gov(www.healthcare.gov) to determine their eligibility for financial assistance in securing coverage and to identify and enroll in a plan.

Wonk Hard II

According to data released by CMS(data.cms.gov), accountable care organizations (ACOs) reduced gross Medicare spending by $836 million in 2016, returning $70.6 million in net savings to the Medicare Trust Fund.

The Medicare Shared Savings Program (MSSP) saved a total of $652 million. Fifty-six percent of MSSP participants reduced their expenditures, and 31 percent reduced expenditures enough to earn shared savings. The Next Generation ACO Model (Next Gen) saved $48M overall, with a net savings to Medicare of $63 million. Eleven of 18 ACOs saved enough to earn a shared savings payment. The Pioneer Accountable Care Organization (ACO) Model produced gross savings of $61 million, with six of eight ACOs reducing spending enough to earn a shared saving payment. The net savings to CMS was $23 million.  

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Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.