Washington — The U.S. Senate’s consideration of the latest Republican health care repeal bill might imperil the federal program that helps states provide health insurance for low-income children, including roughly 116,000 in Michigan.
An extension for the Children’s Health Insurance Program is needed by Sept. 30, when current funding is expected to run out. The program serves 9 million children across the country.
A bipartisan deal announced last week to fund CHIP for five years is now competing for time and resources with the health care bill sponsored by GOP Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina. Senators also face a Sept. 30 deadline to pass that legislation.
U.S. Sen. Debbie Stabenow, D-Lansing, was involved in crafting the bipartisan CHIP agreement. She said the plan was to mark up the CHIP bill in the Finance Committee next week before taking to the Senate floor, where a measure would be added to extend funding for community health centers before funding expires at month’s end.
“All of that has now been put on hold because of this new iteration of repealing health care. I’m very worried about it,” said Stabenow, the ranking Democrat on the Senate Finance Health Subcommittee.
Instead of considering the CHIP legislation, the Finance Committee will hold a hearing on the Graham-Cassidy bill Monday when senators return to Washington.
“It’s all up in the air. It looks like the entire week will be taken up with debating the repeal effort,” Stabenow said.
It remains unclear whether Senate Republicans, who control the chamber, could muster the 50 votes needed for passage after Sen. John McCain, R-Arizona, said Friday he opposes the bill. The GOP can only afford to lose two votes, and two other Republican senators have already said they are voting no or leaning that way.
Some states have said they are preparing to freeze enrollment or limit CHIP coverage if federal funding isn’t extended by the end of the fiscal year on Sept. 30.
In Michigan, CHIP funding is projected to last until April or May, said Angela Minicuci, a spokeswoman for the Michigan Department of Health and Human Services.
“We are monitoring the federal activity very closely,” she said. “Depending on what happens at the federal level, we will work to determine what steps we may need to take in the future.”
Michigan’s program uses CHIP funding to support several programs, including coverage for certain children on Medicaid and mothers who are undocumented immigrants, according to the state health department.
CHIP also provides health insurance for an expanded pool of young people younger than 21 who drank lead-contaminated water from Flint since April 2014, as well as any pregnant women who were served the water, and the children born to them.
Senate Finance Committee Chairman Orrin Hatch, a Utah Republican, is discussing with his members how to proceed on each of the programs with upcoming deadlines, including CHIP.
“Extending funding of the Children’s Health Insurance Program would provide certainty for vulnerable children and their families in Utah and across the country who depend on this essential program,” Hatch said in a statement to The Detroit News.
“I will continue to work with my colleagues on the Finance Committee to advance CHIP and other critical health care provisions within the committee’s jurisdiction in a fiscally responsible manner and as quickly as possible.”
Aside from the time crunch, Stabenow said she was upset to see the last-minute Graham-Cassidy proposal, which “is really poisoning the well in terms of the bipartisan efforts we’ve been trying to do on health care.”
She lamented the discontinuation of talks among a bipartisan group of senators on stabilizing the health insurance markets to bring down costs.
“It’s very concerning to me that there’s a last-minute sneak attack to one more time try to repeal the health care system, and it would affect millions of people in Michigan. It’s worse than the last one,” Stabenow said of the Graham-Cassidy bill.
The Graham-Cassidy proposal would end the Affordable Care Act’s subsidies for private insurance and end the Medicaid expansion for low-income Americans adopted by 31 states, including Michigan.
States would be required to provide “adequate and affordable health care” for patients with pre-existing conditions, Graham and Cassidy have said.
But states could apply for waivers that allow insurers to charge sick patients higher premiums and not cover certain benefits required under the federal health care law, such as prescription drugs and maternity care.
The government would replace some federal spending with lump-sum payments to states until 2027, when those block grants would end without further appropriations from Congress. A study by the consulting firm Avalere Health this week estimated that the bill would mean a $8 billion cut in federal funding for health insurance to Michigan through 2026.
A spokeswoman for Gov. Rick Snyder said he is reviewing the legislation, but Snyder has previously said the state likely couldn’t afford to continue its “Healthy Michigan” program without a replacement for the Medicaid expansion plan’s funding.
The bill complicates the negotiations to extend CHIP, covering 9 million children, while the Senate is debating a proposal that would mean drastic cuts to Medicaid, which covers 37 million children, said Kelly Whitener, a research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.
Whitener predicted that, even if the Senate were to wrap up the Graham-Cassidy bill soon, it’s unlikely they’ll turn around and quickly approve the needed aid for CHIP or community health centers, despite bipartisan support for both programs.
“You can’t go from a really partisan, rancorous debate like that straight into a bipartisan one right away,” she said. “It’s not how we interact as human beings.”