What Happens if the Children’s Health Insurance Plan Isn’t Renewed?

Illustration: Ha Kyung Lee (CC BY-SA 2.0) via Flickr.

“What do you hear when you listen to my heart?” 9-year-old Johary asks.

Johary always has many questions for me. She wants to be a doctor someday. I am a pediatrician in South Los Angeles, and most of my patients, like Johary, are from families who have a hard time making ends meet. I love talking to the children about what they want to be when they grow up, especially when those plans include becoming a doctor.

Johary’s parents are legal immigrants from El Salvador. They have lived in Los Angeles for nearly 20 years. Johary’s mother, Karla Ceron, works as a nursing assistant and her father, Arturo Castro, is a truck driver. Their fulltime jobs don’t come with health benefits and they can’t afford private insurance. Fortunately, Johary and her older brother and sister qualify for Medi-Cal through the Child Health Insurance Program (CHIP).

Johary and her mother, Karla Ceron. Photo credit: Chris Mink.

Medi-Cal is California’s version of the federal Medicaid program. Medicaid provides health coverage for vulnerable populations, including many people who are low-income, elderly, disabled, pregnant or younger than 19. The program is the single largest health insurance provider in the U.S., covering nearly 72.5 million people, including 37 million children.

CHIP provides coverage for uninsured children whose families would otherwise earn too much to qualify for Medi-Cal. The income limit to qualify for CHIP is about $65,500 for a family of four in California. Without CHIP, a family of 4 could earn no more than $33,500 to qualify for Medi-Cal.

Last year, CHIP insured 8.9 million children in the U.S. and more than 1.9 million kids in California. The program covers preventive care, developmental services, rehabilitation programs, dental care, and routine vision and hearing exams, among other services. Most CHIP programs, including California’s program, also cover mental health care.  

Between CHIP and Medi-Cal, which California expanded with funds from the Affordable Care Act, a record high of more than 96 percent of California kids now have health insurance. Together, the programs insure seven out of 10 California children.

CHIP, which was introduced in 1997, has historically enjoyed strong bipartisan support, but that’s no longer the case. Federal funding for the program ends on Sept. 30 and its renewal has been uncertain. Without prompt extension, millions of children may lose their access to quality, age-appropriate health care. California’s CHIP program will be out of money by March 2018 if the program isn’t renewed at the federal level. Three states and the District of Columbia will run out of funds by the end of 2017.

Earlier this month, Utah Republican Sen. Orrin Hatch, the chair of the Senate Finance Committee, and Oregon’s Democratic Sen. Ron Wyden, announced an agreement to extend CHIP funding for five years. The senators have said that the proposal phases out the additional funds for Medicaid made available with the Affordable Care Act, but the full text of the legislation is not yet available.

Hatch was one of the original authors of the CHIP legislation along with then-Massachusetts Democratic Sen. Ted Kennedy.

“Insurance allows children to maintain access to quality care,” explained Peter Szilagyi, professor of pediatrics at David Geffen School of Medicine at UCLA and a commissioner for the Medicaid and CHIP Payment and Access Commission. Research has shown that children with insurance are healthier. They receive more preventive care, miss fewer school days and their parents miss less work.

Ceron, Johary’s mother, has always used her children’s insurance through CHIP for preventive care. “I always make sure the kids have check-ups and get their vaccines,” she said.

The true value of health insurance, however, didn’t hit the family until last fall.

While listening to Johary’s heart, I heard an extra sound, a murmur, and referred her to a cardiologist. Her diagnosis was an atrial septum defect, which means that she has a hole in the wall between the two upper chambers of her heart. The hole had to be fixed to allow her to keep growing.

Johary’s heart was repaired—without ruining her family’s finances—because she has health insurance. The national average cost for the procedure is about $64,000, significantly more than her parents earned in a year.

Johary has made a full recovery. She still wants to be a doctor. She’s off to a good start—she was a star at her school’s science fair. Her project was about the heart.

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