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The Fight Over CHIP Has Reached New Heights of Absurdity (or Depths of Cruelty)

Congress’s failure to reauthorize the Children’s Health Insurance Program is becoming ever more absurd and potentially devastating by the day.

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Back in December, lawmakers passed a temporary funding bill meant to keep the widely popular program running through March, since they had failed to agree on how to fund a full, five-year reauthorization of the law. But it turns out that the $2.8 billion Congress set aside may not have been enough. Late last week, the Trump administration warned that some state CHIP programs could start running out of money as soon as this month.

“The funding … should carry all the states through January 19, based upon best estimates of state expenditures to date,” Centers for Medicare and Medicaid Services spokesman Johnathan Monroe told NPR. “However, due to a number of variables relating to state expenditure rates and reporting, we are unable to say with certainty whether there is enough funding for every state to continue its CHIP program through March 31, 2018.”

Failing to reauthorize CHIP before states exhaust their funding would be a pointless debacle. The program provides insurance to roughly 9 million lower-income children whose parents earn too much to qualify for Medicaid. If Congress doesn’t act, many of those kids could end up losing their coverage outright, just as states warned before the stopgap passed last month.

Everybody agrees this would be be a very, very bad thing. CHIP is one of the few federal programs with broad bipartisan support. Utah Sen. Orrin Hatch, who now chairs the Senate Finance Committee, helped create it back in 1997, a fact that he brings up every time reporters ask him why he hasn’t just gone ahead and made a deal to renew it. But the GOP is notoriously willing to put programs they acknowledge are important in peril for the sake of separate political objectives, and as such, they’ve decided to try and extract painful spending cuts in return for extending health insurance for kids. In November, before the party turned its attention entirely toward taxes, Republicans proposed raiding a preventative care fund set up under Obamacare to fund. This was a non-starter for Democrats—that pool of money finances valuable health care efforts like vaccination and diabetes programs—and the two sides ended up at loggerheads.

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But now, the question of how to fund CHIP going forward has been rendered all but moot. That’s because the Congressional Budget Office recently updated its estimate of how much reauthorizing the law would cost. Where before extending the program through 2022 would have required $8.2 billion, the scorekeepers now think it would take just a measly $800 million.* The smaller price tag is an unexpected side-effect of the GOP’s decision to fund their tax bill by killing the Affordable Care Act’s individual mandate—a move that’s widely expected to drive up insurance premiums on the individual market. The CBO believes that many children who lose CHIP will simply end up enrolled in Obamacare coverage, which, thanks to the mandate’s demise, will now cost the government more to subsidize. As a result, keeping CHIP up and running now looks relatively cheaper than before. Much cheaper.

Bottom line: Thanks to an odd twist of budgetary fate, Congress could keep CHIP running for couch cushion money—an amount so small it barely merits a budgetary offset, especially in the wake of a $1.5 trillion tax cut. The president could probably cover much of the expense by limiting his golf-time, if anybody was really desperate to scrounge up some lose change. There is absolutely no reason why Republicans shouldn’t bring renewal up for a vote immediately, before states run into peril. To wait any longer would show nothing but pure callousness towards American parents and children.

*Correction, Jan. 9, 2018: This post incorrectly stated that extending CHIP for 10 years would cost $800 million according to the CBO’s original analysis. That was the cost of extending the program for 5 years.