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House Volleys CHIP Measure to Senate

Issue of offsets to cost are major sticking point

The House passed a reauthorization of CHIP, and now it’s the Senate's turn to consider renewing the health insurance program’s funding. (Bill Clark/CQ Roll Call)
The House passed a reauthorization of CHIP, and now it’s the Senate's turn to consider renewing the health insurance program’s funding. (Bill Clark/CQ Roll Call)

After months of disputes and delays, the House voted Friday to renew funding for the Children’s Health Insurance Program, community health centers and other public health programs. The legislation passed easily, 242-174, although many Democrats opposed the measure due to disagreements over the offsets.

“Three times at the request of the Democrats, we delayed committee action,” said Energy and Commerce Chairman Greg Walden of Oregon. “These delays meant Congress went past the deadline of Sept. 30. We cannot wait any longer. Patients cannot wait any longer.”

Democrats disagreed, saying CHIP should have been addressed earlier in the year.

“House Republicans chose to spend the first nine months of this year trying to repeal the Affordable Care Act,” said Energy and Commerce ranking member Frank Pallone Jr. of New Jersey.

Advocacy organizations and state officials have been clamoring for Congress to act to extend funding for CHIP, community health centers and a number of other safety net programs. Most still had some money to keep operations going after the Sept. 30 expiration date, but officials are increasingly nervous about running out. In the case of CHIP, federal health officials have been funneling some leftover funds to the states that are in the most dire situations.

Now the bill needs to pass the Senate, where it may face some pushback.

“If this bill is partisan, it will never become law. It will go to the Senate and sit there,” Pallone said.

The Senate has its own version. It mirrors the House bill’s five-year extension for CHIP, would retain the same eligibility requirements and would phase out a funding bump in previous laws. But the Senate bill has the support of both parties in part because it does not include offsets, the issue that sparked the fight in the House.

House Republicans defended their cuts.

“The offsets are not draconian,” said Michael C. Burgess of Texas, chairman of the Energy and Commerce Health Subcommittee. “We have ourselves a bill today that will fund some of the nation’s most important public health programs.”

On Thursday, 22 Democratic senators wrote a letter to Majority Leader Mitch McConnell and Minority Leader Charles E. Schumer voicing opposition to funding CHIP through cuts to the Prevention and Public Health Fund, which provides money for vaccines, smoking cessation assistance and other programs intended to improve people’s health.

The offsets in the House bill include a $6.35 billion cut to the prevention fund over 10 years, increased premiums for Medicare recipients making over $500,000 a year and limits to Medicaid benefits for lottery winners. In addition, the bill would reduce the grace period for health exchange plans from 90 days to either 30 days or whatever time frame a state chooses to set. It would also change Medicaid third-party liability — which would bill an individual’s supplemental insurance before Medicaid, if applicable.

Both the House and Senate bills maintain a 23-percentage point funding bump that was provided in earlier laws for the first two years, after which the boost eases to 11.5 percent and returns to traditional levels for the final two years. The bills would retain existing maintenance-of-effort requirements to prevent states from reducing eligibility through fiscal year 2019, and for children below 300 percent of the federal poverty line through fiscal year 2022.

The legislation would also extend funding for community health centers and other public health programs such as the Special Diabetes Program and the National Health Service Corps for two years each. It would delay funding cuts to disproportionate share hospitals for two years, and would increase funding up to about $1 billion for the U.S. Virgin Islands and Puerto Rico’s Medicaid program.

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