The Children’s Health Insurance Program has been running on fumes for more than one hundred days. The program provides health insurance for 9 million children in low-income families. But millions of those children stand on the brink of losing coverage because the Republican-controlled Congress hasn’t bothered to renew long-term funding for the program. It’s a needless crisis—and a stark reminder that when progressives are in power, they must fortify government to withstand neglect and ruin at the hands of the right.
Since its inception twenty years ago, CHIP has been an uncontroversial program with bipartisan support. But funding for the program ran out at the end of September. Two leading senators had struck a bipartisan agreement to extend CHIP’s funding earlier that month, but the GOP’s last-ditch push to repeal Obamacare swallowed up their deal. After Obamacare repeal failed again, Senate Republican leadership leaped straight into tax reform, and the CHIP deal faded away.
Meanwhile, state CHIP programs are quickly running out of money to keep kids insured. Congress kicked the crisis a few months down the road before breaking for the holidays, passing short-term funding meant to keep CHIP afloat until March. But that funding actually may not even be enough to sustain CHIP through the end of January in some states, according to the Centers for Medicare & Medicaid Services. Congressional recklessness has already exacted a psychic toll on families frantic at the prospect of their children losing access to health care, with some states sending letters to families warning that they will be forced to terminate coverage without action by Congress, and others readying emergency plans to wind down their CHIP programs entirely.
In the midst of this crisis, Republicans in the House played politics with the issue. At the end of October, they proposed to fund CHIP in part by shortening the grace period for Obamacare enrollees who miss a premium payment. This would pay for CHIP using money saved on Obamacare subsidies after throwing people off of their insurance faster. It was a poison pill bill—Republicans knew Democrats wouldn’t support any move to weaken Obamacare—but the House passed it along party lines anyway.
Since then, Republicans enacted a tax bill that could leave up to 13 million fewer people with health insurance—meaning there now may be fewer bounced premiums to draw on to fund CHIP. That tax bill sucked up all of the oxygen in Washington, along with most of the revenue. Even Sen. Orrin Hatch—one of CHIP’s original sponsors—bemoaned that renewing CHIP is difficult “because we don’t have money anymore.” Yet he and his GOP colleagues had no trouble finding the money—plus stomaching $1 trillion in new federal debt—for the sake of cutting taxes primarily on the wealthy and corporations.
This isn’t a surprise—conservatives have long pledged fealty to Tax Cut Exceptionalism. Many believe there’s no need to pay for tax cuts at all, while social insurance programs should be paid for by robbing one to pay for another. It’s part of a larger strategy to shrink the size of government by starving it of funds—one that inevitably targets programs that serve the poor and vulnerable.
CHIP serves a relatively narrow subset of American children whose parents earn too much to qualify for Medicaid but too little to afford private coverage. It’s usually temporary coverage that children weave in and out of as their parents’ incomes rise and fall—a safety net that families can fall back on in hard times.
CHIP may have been a bipartisan priority once upon a time. But progressives must reckon with the modern GOP, which is no longer a reliable partner in support of any social welfare program. It is now a nihilistic party that rejects any role of government to do things like expand healthcare coverage. This puts a program like CHIP squarely in the crosshairs when Republicans are in power.
So when the political pendulum swings back to the left, progressives must tailor their agenda with an eye toward Republican-proofing government. That means making important public programs too big to cut. For instance, Democrats could transform children’s health insurance into a commitment to provide automatic Medicare coverage for all American children starting at birth. As progressives from Lyndon Johnson’s administration on through Sen. Bernie Sanders have proposed, American children should receive a Medicare card when they are born, covering their healthcare needs up until early adulthood.
By enlisting all American children into one healthcare program, Medicare-for-Kids would become another third rail too politically painful for conservatives to attack. Moreover, because Medicare is funded through payroll taxes, children’s coverage would no longer be subject to the gamesmanship of congressional deal-making.
Conservatives recognize that expanding social insurance programs makes these programs stronger, and therefore resist expansion attempts accordingly. Over a decade ago, a bipartisan coalition in Congress passed a bill that would have expanded CHIP and covered more children. President George W. Bush vetoed the CHIP expansion twice, saying that it “moves our country’s health care system in the wrong direction” by supposedly threatening private insurance. The CHIP expansion became law shortly after President Barack Obama took office in 2009.
The bill that Obama signed had notably less Republican support than the bills passed out of Congress under Bush—an early sign of the hardening anti-healthcare direction of the GOP. That shift is now complete. Congress may still avert total disaster and pass meaningful CHIP funding. But this calamitous episode should remind progressives of the need to ratchet up the welfare state so that it can survive shifts in the political winds. Health insurance for children and similar programs must be bolstered to weather the cold during periods of conservative rule.