Vice President for Health Policy
House Republicans’ “continuing resolution” to fund the federal government through January 19 includes bills to continue funding the Children’s Health Insurance Program (CHIP) and community health centers. But those bills suffer from the same fatal flaws as House GOP bills from earlier this fall that have derailed action on these issues for months — even though some states are notifying families that their CHIP coverage will soon end and are planning to cut or end their CHIP programs early next year. The flaws include:
Damaging financing provisions to help pay for the funding extensions. The spending package includes a harmful provision, which we’ve described here, that would take insurance away from up to 688,000 low- and moderate-income people each year who miss a premium payment for marketplace coverage. It would also deeply cut the Affordable Care Act’s Prevention and Public Health Fund, which provides essential support for Centers for Disease Control and Prevention programs in areas such as responding to infectious disease outbreaks, reducing tobacco use, and immunizing children.
The package also includes Medicaid and Medicare cuts, such as by requiring very high-income Medicare beneficiaries to cover the entire cost of their premiums. That could cause some high-income people to drop coverage altogether, which would worsen the Medicare risk pool (since healthier people would likelier drop coverage) and weaken support for Medicare as a universal social insurance program.
Highly inadequate Medicaid assistance for Puerto Rico and the Virgin Islands. Like the House Republican CHIP funding bill from October, the spending package includes $1 billion in additional federal Medicaid funding for Puerto Rico and roughly $30 million for the U.S. Virgin Islands. That falls well short of what those U.S. territories need in the aftermath of Hurricanes Maria and Irma.
As we’ve explained, policymakers need to take three steps to enable Puerto Rico and the Virgin Islands to continue providing needed Medicaid coverage to eligible residents: first, temporarily raise the federal matching rate to 100 percent, because neither Puerto Rico nor the Virgin Islands will be able to finance its current share of Medicaid costs anytime soon; second, increase the islands’ Medicaid block grants (unlike for states, federal Medicaid funding for the territories is capped) enough to both accommodate the rise in the match rate and avert federal funding shortfalls that Puerto Rico faced before the hurricanes; and third, ensure 100 percent federal funding for state Medicaid costs related to caring for evacuees from Puerto Rico and the Virgin Islands, as the federal government did with Hurricane Katrina evacuees.
The House Republican package, however, doesn’t include a matching rate increase or any provision for evacuees. And its overall funding increase would only enable Puerto Rico to sustain its pre-hurricane Medicaid program through fiscal year 2018. That’s far from adequate, since many more residents will likely need Medicaid due to the hurricanes and their average medical needs will likely be greater.
In the next week, the President and Congress need to enact funding extensions for CHIP and community health centers to address the growing crisis in both areas. House Republicans can do so by returning to bipartisan, bicameral negotiations to find non-damaging financing provisions that don’t reduce health coverage. They should also ensure adequate federal Medicaid funding for Puerto Rico and the Virgin Islands, as well as provide other needed post-hurricane assistance such as meeting their residents’ basic needs and rebuilding the islands’ hospitals, clinics, and other health infrastructure.