On November 3, the House passed (242-174) a bill to renew funding for the Children’s Health Insurance Program (CHIP), community health centers, and several other health-related programs. Funding for CHIP expired on September 30; states have been able to keep operations going thus far, though five states and four U.S. territories required extra money from the federal government to keep their programs going.

While advocates are pleased that Congress seems to be in agreement that funding should be extended for five years, they disagree with how the House bill would pay for this funding, saying these provisions would interrupt coverage and harm beneficiaries. For example, the House bill would cut the Prevention and Public Health Fund by $6.35 billion over 10 years. Established by the Affordable Care Act, the fund provides vital support to state public health departments and the Centers for Disease Control and Prevention. The House bill also would increase Medicare premiums for higher-income enrollees.

According to Families USA, the House plan would also allow insurers under the Affordable Care Act to dramatically reduce “grace periods” for consumers who are late with a payment. Instead of the current three-month grace period, insurers could terminate health coverage if a consumer is 30 days late with a single premium payment. The nonpartisan Congressional Budget Office estimates that up to 500,000 people a year could lose coverage as a result. In addition, the bill would allow insurers to deny health care to pregnant women and children while back-office billing issues are being resolved. Advocates fear the resulting delays in care could lead to harmful birth outcomes and children’s developmental delays.

Five states and the District of Columbia are estimating they could run out of funds by the end of this year or early January, according to a report from the Georgetown Center for Children and Families. Several other states may begin sending families notices that their children will soon lose or be denied CHIP coverage, despite qualifying for it, due to lack of funds. Advocates fear this will cause confusion and undue stress for families, and ultimately, loss of coverage if Congress does not act soon. More than 9 million children currently receive health care coverage under CHIP.

The Senate version of the bill also includes a five-year extension for CHIP and has bipartisan support. The Senate bill currently does not include the controversial offsets, or “pay-fors,” that the House bill includes, though it is unclear what offsets will be in the Senate bill. Rather than the Senate passing a stand-alone CHIP bill, it is rumored that Congress may try to pass a consolidated health package in December that would include funding for CHIP, community health centers, the maternal and infant home visiting program, and others. The package could also include legislation by Senators Alexander (R-TN) and Murray (D-WA) that would continue the payments to insurance companies (known as cost-sharing reductions, or CSRs). CSR payments cover the insurers’ costs of lowering deductibles and other out-of-pocket costs for lower-income marketplace enrollees; the Trump administration announced in October that it would halt CSR payments. A consolidated health package could also be added to whatever year-end spending deal Congress reaches. Advocates are concerned about what offsets may be used to pay for the package, which is currently estimated to cost around $25 billion.

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