If Congress does nothing, which it very well might, 3,500 low-income children and pregnant women in Boulder County will lose their health insurance on Jan. 31.
The something Congress needs to do to keep that from happening to those 3,500 people (and 75,000 more kids in Colorado) is restore funding to the Children’s Health Insurance Program, which covers insurance for low-income children and pregnant women across the country who make too much to qualify for Medicaid, but still fall within 260 percent of the federal poverty level.
In Colorado, those federal funds cover up to 88 percent of the state’s Child Health Plan Plus (CHP+) program, the state’s mechanism for insuring qualified children and pregnant women.
Though it’s been widely reported that the program has received bipartisan support since its inception in 1997, Congress already missed their deadline to reinstate funding to the program. And this week, the Colorado Department of Health Care Policy and Financing (HCPF) began sending out letters to enrollees of the program telling them to start preparing for a loss in coverage (full disclosure: my family received one of these letters). The inaction has befuddled advocates of low-income families as the program reduced the rate of uninsured kids from 7.9 percent in 2009 to 2.5 percent in 2015.
“Numerous people, organizations and providers have expressed concern over the fate of the CHP+ program,” says Marc Williams, public information officer for the state HCPF. “Any time there’s a threat to a popular program like CHP+, we hear those concerns and this is no different. There is no upside in allowing the CHP+ program to discontinue its coverages.”
Susan Wortman, development director at Clinica, a local clinic that servs about 500 CHP+ patients in Boulder County, says the type of care CHP+ enrollees will lose coverage for is basic and critical.
“Anything from diagnosing a women when she becomes pregnant, to all the prenatal care, to all the deliveries, immunizations. [We help] people manage chronic disease like hypertension, diabetes. Kids who come to us are generally getting all their well child sports physicals, immunization flu shots, and we manage all the other things that might come up — if they need behavioral health counseling, making sure they have access to meds they might need,” Wortman says.
If CHP+ loses funding, enrolling families will have few options to replace that insurance: They can either reapply for Medicaid and see if they qualify (Williams says the state is unlikely to broaden its Medicaid standards to envelop those who would lose CHP+ coverage); or they can sign up for a plan on the marketplace and hope for federal subsidies.
But that might create a significant financial burden for families. For instance, it’s free for most pregnant women to enroll in the program, and children’s care costs a one-time fee between $25 and $105. Compare that to a standard health insurance plan, where, even with federal subsidies, premiums can cost hundreds of dollars per person, which is on top of paying for procedures before deductibles of several thousand dollars are met — deductibles a woman delivering a child would certainly meet. Those are costs many low-income families just can’t meet, and certainly they would have to be more judicious about when to visit the doctor.
“If the CHP+ program were to end and a pregnant woman or child didn’t have other insurance to pick up where CHP+ left off, they would be uninsured,” Williams says. “Naturally we hope it doesn’t come to that.”
Still, given that every family would be eligible for different subsidies if CHP+ does not receive funding, families are now left in the dark as to how much they might have to pay next year.
“It would be impossible to really estimate,” says Jim Williams, Boulder County Housing and Human Services spokesperson. “The financial assistance that is available through Connect for Health Colorado (the state insurance marketplace) can be significant. It can greatly reduce the amount you spend on premiums; [it] might be similar to what you would spend on CHP+.”
“CHP+ families should be eligible for tax subsidies to help bring those costs down,” says the state’s Marc Williams, emphasizing the word “should.”
Outside of congressional action, there’s not a lot of hope for families who rely on CHP+. Kristina Iodice is the public information officer in El Paso County, which has the highest concentration of CHP+ enrollees in the state. Though the County is preparing residents for the change, there’s only so much they can do.
“Of course this is a concern because it will impact a lot of families, but there’s not a lot that can be done at the county level,” she says.
Marc Williams says it would take $159 million for Colorado to fund CHP+ on its own. The HCPF hasn’t requested funding, Williams says, but he adds “any member of the legislature could introduce a bill on their own requesting the state pay for CHP+ if the feds do not renew funding.”
On the federal level, there are currently two bills, one in the House, one in the Senate, that would restore funding, but there is disagreement about from where to draw the money to fund the program, and progress on passing those bills has stalled. Senators Cory Gardner and Michael Bennet co-sponsored the proposed Senate bill.
Until then, families are advised that coverage will not change in Colorado until Jan. 31, 2018. In the meantime, families were advised this week to seek alternatives, as sparse as they may be.