With the Affordable Care Act seemingly off to a good start in its first year, increasing access to insurance coverage for adults, attention is likely to turn to an older program for children that will come to an end in 2015 if it is not reauthorized: the Children’s Health Insurance Program, or CHIP.
This program has made a huge difference in insurance coverage for children, so much so that they are not, and did not need to be, the primary beneficiaries of the A.C.A. But that does not mean that children are not a concern. A variety of factors about our national strategy for children’s health care, or our lack of one, leaves them particularly vulnerable to challenges in access and quality in the next few years.
Children have not always fared so well. From 1980 through 1984, the rates of uninsured children and non-elderly adults were almost identical. Since that time, they have diverged significantly, so that in 2012, about 15 percentage points separated the two.
This turn of events was achieved though expansions of public coverage, specifically Medicaid, in the 1984 Deficit Reduction Act, and the Children’s Health Insurance Program, in the 1997 Balanced Budget Act. In 2013, more than 41 percent of children were insured through a government program, making them more dependent on public coverage than any group except seniors.
When the Affordable Care Act was passed, Congress also reauthorized the CHIP program. As a recent Health Affairs review reports, this was done “out of an abundance of caution.” CHIP is now funded through fiscal year 2015. If it is allowed to expire after that, in some respects it might not be a calamity: Most of the children insured through CHIP would qualify for plans offered in the health insurance exchanges.
There are still many reasons to be concerned about the end of CHIP, though. CHIP plans have an actuarial value of greater than 90 percent, making them much more generous than A.C.A. silver benchmark plans, with an actuarial value of 70 percent, meaning the plan covers 70 percent of health care costs. The increased cost-sharing families might encounter by moving to private plans might leave even more children underinsured. Deductibles, co-pays, coinsurance and even premiums are usually much lower in CHIP plans than in exchange plans.