September 30 marked the final day of Fiscal Year (FY) 2017, and with it, the expiration of funding for a number of federal health programs, including Children’s Health Insurance Program (CHIP), community health centers and disproportionate share hospitals (DSH). It is expected that a final legislative package extending funding for CHIP, which provides health insurance to children in families with incomes that are modest but too high to qualify for Medicaid, will likely include funding for the other health safety net programs.
Since its inception in 1997, CHIP has carried broad bipartisan support in Congress. Together, CHIP and Medicaid insure over 30 million children and cover a range of health services, such as prenatal doctor visits for pregnant women and dental checkups for young children. In 780 of the nation’s 3,069 counties, over 50 percent of children receive health insurance coverage under Medicaid or CHIP. Like Medicaid, counties sometimes help states finance and administer the CHIP program. Additionally, counties support efforts to improve health coverage and ensure low-income residents, families and children have access to affordable, high-quality health care.
CHIP was last reauthorized for two years under the “Medicare Access and CHIP Reauthorization Act of 2015.” The bill funded CHIP for FY 2016 and FY 2017 at approximately $13.9 billion and $15.9 billion, respectively, according to the Medicaid and CHIP Payment and Access Commission (MACPAC).
Efforts to repeal and replace the Affordable Care Act sidelined congressional efforts to reach a bicameral agreement to reauthorize CHIP by the September 30 deadline.
On October 4, committees of jurisdiction in both the U.S. House of Representatives and the U.S. Senate advanced legislative proposals that would reauthorize CHIP. However, the bills contain significant differences in their funding structures that must be negotiated before a final reauthorization package is approved. The Senate bill, the “Keeping Kids’ Insurance Dependable and Secure (KIDS) Act” (S. 1827), would reauthorize CHIP for five years, but does not specify the budgetary offsets to pay for this funding extension.
Across the Capitol, the U.S. House of Representatives Energy and Commerce Committee advanced legislation on a partisan vote to reauthorize multiple health programs, including CHIP and community health centers. Their bill to reauthorize CHIP, the “Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable (HEALTHY KIDS) Act of 2017” (H.R. 3921), would reauthorize CHIP for five years, and additionally contains other provisions delaying the scheduled cuts to DSH payments by one year and provide $1 billion in Medicaid funds to Puerto Rico. Offsets include charging higher Medicare premiums to wealthier seniors and allowing states to dis-enroll lottery winners from the Medicaid program.
The U.S. House Energy and Commerce Committee also approved a separate piece of legislation, the “Community Health And Medical Professionals Improve Our Nation Act (CHAMPION Act) of 2017” (H.R. 3922), which would reauthorize community health centers for two years, in addition to other health programs. However, the bill would be offset by a $6.35 billion cut in future appropriations to the Prevention and Public Health Fund. The PPHF provides approximately $900 million annually in support of state and local public health and prevention efforts, including activities like immunizations and diabetes prevention efforts. This federal funding source is extremely important to the nation’s 2,800 local public health departments, two-thirds of which are county-based.
NACo supports congressional efforts to extend CHIP, community health centers, scheduled cuts to DSH payments and other health safety net programs, but strongly opposes efforts to cut federal funding for the Prevention and Public Health Fund. Cuts to this fund would be a blow to already-strained county public health departments and inhibit their ability to implement activities that keep their residents healthy and safe.
If Congress is not able to pass legislation to extend funding for these programs over the next few months, they could attach these into a must-pass legislative package when the continuing resolution and debt limit extension expires December 8. NACo will continue to monitor legislative developments and their potential impact to counties.
For more NACo resources on health care programs, please see the following: