Playing the role of Scrooge tonight--it's the US Congress!

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Dec 19 2017
Dr. V. Ram Krishnamoorthi and Dr. Philip A. Verhoef
Crain's Chicago Business
http://www.chicagobusiness.com/article/20171219/OPINION/171219880/playing-the-role-of-scrooge-tonight-x2014-its-the-u-s-congress?utm_source=OPINION&utm_medium=rss&utm_campaign=chicagobusiness

As we ponder Congress' failure to reauthorize funding for the Children's Health Insurance Program, we ask our elected leaders to revisit Charles Dickens' "A Christmas Carol." When asked for a donation to support the "poor and destitute," Ebenezer Scrooge declined, suggesting that the underprivileged "had better (die), and decrease the surplus population."

We can't help but think of this line when considering the fate of CHIP, which Congress passed in 1997 with the intention of providing health coverage for uninsured children from low-income families who do not qualify for Medicaid. Prior to CHIP, more than 10 million children had no health insurance. As a consequence, the health of these children was markedly poorer than patients with insurance, on every measure: the ability to access timely care, the presence of a medical home or primary care provider, measures of chronic disease control, and school functioning.

Read more: Why some kids are going back to school without vaccines

Most shockingly, these children were more likely to die for lack of insurance.

In Illinois, CHIP is administered as an extension of Medicaid. In our state, a family of three with an annual income of less than about $65,000 can qualify. These programs cover approximately one-third of children around the country, but at the University of Chicago (where we practice), more than two-thirds of our pediatric patients depend on Medicaid and CHIP for care.

But we face a problem: Funding for CHIP expired without reauthorization on Sept. 30. It didn't have to. After failing to pass any legislation on health care this year, Congress allowed federal support to be cut off for a program that covers 9 million children. Some states have already issued notices to families that their children may no longer be covered for their doctor's visits and hospitalizations. In Illinois, the CHIP program is estimated to run out of money midway through 2018. But instead of passing a simple bill to reauthorize funding for the long term, congressional leaders are using CHIP as a bargaining tool by attaching it to unrelated spending bills, which themselves may not pass before the end of the year.

Our fear is that, if legislators continue to politicize CHIP funding, they will destabilize the entire program. Without a stable foundation of federal money, states are unable to budget for, much less cover, the current needs of their most vulnerable people.

Research tells us that loss of health insurance leads to preventable deaths, or as Mr. Scrooge might say, a reduction in "the surplus population"—who, in this case, are children.

 

Dr. V. Ram Krishnamoorthi is an assistant professor of medicine at the University of Chicago Pritzker School of Medicine. Dr. Philip A. Verhoef is an assistant professor of medicine and pediatrics at UChicago Medicine.

Comments

We need one national one health plan. We need everybody in, nobody out.

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