Professor of Pediatrics Aaron Carroll, who wrote the piece, notes the concern about children who may have no health insurance whatever — about 2.2 million, according to one count. But he focuses mainly on concerns for those who will have coverage because their parents have an affordable family plan purchased on a health insurance exchange.
Or we surely hope so. As you’ve probably read, the Supreme Court has been asked to rule that the federal government can’t subsidize plans purchased on the exchange it established for people who live in states that didn’t create their own.
Many trustworthy experts think the Court won’t. But if it does, as many as five million children could wind up with no affordable health insurance, according to a friend-of-the-court brief filed by the American Academy of Pediatrics and seven other organizations engaged in healthcare services and advocacy for children.
Carroll doesn’t allude to this doomsday scenario. He instead makes several points in favor of renewing CHIP funding, even with the subsidies intact.
The first is that CHIP covers a larger portion of children’s healthcare costs — more than 90%, as compared to 70% in the mid-level silver benchmark plans the Affordable Care Act provides for.
A troublesome difference. Some parents, however, might opt for plans with rock-bottom monthly premiums, but even higher deductibles and other out-of-pockets. This could cause them to forgo needed care — for themselves and perhaps their children.
Cost aside, Carroll raises several concerns about the health care children could receive through plans available on the exchanges. They’re rooted in the fact that the plans, unlike CHIP, aren’t tailored to children’s healthcare needs.
The problem begins with the ACA itself. The law establishes essential benefits that all plans must cover, both those offered directly to individuals and those small employers can purchase. They include pediatric services, with vision and dental care specified.
For reasons known best to the U.S. Department of Health and Human Services, the rules are silent on all but the two named services. And they allow for a separate, optional dental care plan — at an additional, unsubsidized cost — rather than requiring coverage in the overall plan.
I don’t suppose I need to elaborate the potential consequences for low-income children.
More generally, the failure to specify essential pediatric services has allowed states to choose as the basis for their minimum requirements plans that exclude a variety of healthcare services for children.
Carroll cites, among others, services for children with learning disabilities and autism. He also notes gaps in services expressly required, e.g., care of congenital defects, hearing aids and implants for children whom hearing aids can’t help.
Another related variation applies to plans families may purchase. Some, Carroll says, have very narrow networks, i.e., hospitals and physicians whose services the insurance company will pay for.
They’re narrow for providers of pediatric care than care for adults — and especially narrow for providers of specialty care, he adds. The narrow-network plans tend to be cheaper. And we’ve some evidence that many purchasers don’t understand the trade-off.
So parents may learn, when it’s too late, that there’s no in-network children’s hospital or other source of affordable services from doctors trained to treat children with complex, chronic conditions.
What’s rather strange about CHIP is that the ACA extends it through Fiscal Year 2019 — and sets a higher federal match rate for states’ costs beginning in Fiscal Year 2016. Yet it gives the federal government authority to spend money on the program only through this fiscal year.
States may have some leftover funding, but it’s unlikely to last through the year. There’d still be a match for low-income children who’ve been served through Medicaid, rather than separate CHIP programs, but it could be lower. It would definitely be lower for the children states shifted into Medicaid, as the ACA required.
For the rest, there’s no assurance state exchanges would have insurance plans with benefits and cost-sharing comparable to CHIP. Carroll’s analysis suggests that many don’t now. They could, but wouldn’t have to if CHIP funding dries up.
Surely it would be irresponsible to let CHIP funding lapse and see what happens. If children’s health problems aren’t promptly and expertly diagnosed and/or don’t get appropriate treatment, no one can remedy the harms by restoring CHIP or refining the ACA later.