WASHINGTON — Despite widespread bipartisan support for the Children's Health Insurance Program, lawmakers on Capitol Hill remain uncertain just when and how the lapsed program might get a renewal.
Louisiana will begin running out of federal dollars to operate the program sometime in January, according to the Governor's Office, forcing the state either to shift funds from other health care programs or to cancel coverage for kids.
Gov. John Bel Edwards sent the state's congressional delegation a letter Wednesday urging them to move swiftly to renew CHIP. The program expired at the end of September.
Existing federal CHIP funds have given lawmakers considerable cushion as negotiations over the program have dragged on. No state has yet run out of cash — though several are running dangerously low — even though CHIP's authorization lapsed on Sept. 30.
Funding for local clinics known as federally qualified health centers are also included in the CHIP authorization.
Lawmakers on Capitol Hill expressed optimism this week that they'd renew CHIP before the end of the year. But with Congress tied up in high-stakes negotiations over a broader government funding deal and a sweeping GOP tax-cut plan, it remained unclear when the program would be addressed.
Edwards notes in his letter that the program covers 122,000 children in Louisiana, most of them from poor or low-income families and points to studies indicating that children covered by the program fare better in later life.
Edwards said state taxpayers would need to cover at least an additional $126 million per year beginning in January to keep CHIP running if federal funding isn't renewed.
"With dire budget problems at our doorstep," Edwards wrote, referring to a stretched state budget and looming fiscal cliff, "we would be hard-pressed to maintain current levels of health care access for these vulnerable children."
The program has also helped Louisiana cut the proportion of uninsured children in the state from 11 percent in 2003 to just under 4 percent in 2015, Edwards said.
The future of the program "shouldn't be uncertain," said U.S. Rep. Ralph Abraham, R-Alto, a physician who said he's treated a number of CHIP recipients in his rural practice. "These are our most vulnerable children that really don't have, unfortunately, any say in the matter. These are infants and small children that need health care."
Despite the program's widespread popularity — several lawmakers, including U.S. Sen. Bill Cassidy, R-Louisiana, have held it up in the past as a model of bipartisan agreement — disputes over how to pay for it have held up reauthorization.
A GOP-backed effort in the House of Representatives would have renewed the program largely by dipping into a preventative health fund set up under the Affordable Care Act and by trimming Medicare funding for high-earning seniors.
Those "pay-fors" outraged Democrats and left CHIP stalled in the Senate, where a narrow Republican majority means at least a handful of Democrats are needed to pass legislation.
"Both sides agree that the Children’s Health Insurance Program and community health center funding is vitally important and we’re going to get it done and we’ll get it done before states start running out of money," said Rep. Cedric Richmond, D-New Orleans.
House Republicans "tried to make it a zero-sum game like if we give health insurance to some we have to take it from others," said Richmond, the chairman of the Congressional Black Caucus. "No, we can actually take care of everyone. That’s our position and I think at the end of the day the Senate is going to agree with our position."
Abraham said that, as a fiscal conservative, he's been mindful of where money to continue the program comes from.
"But this is important — these children need insurance," Abraham said. "If they are uninsured, they end up in the hospital more and the cost will exponentially up if we don't take care of them in a primary care setting."
U.S. Rep. Garret Graves, R-Baton Rouge, said he anticipates — "at a minimum" — additional funding flexibility to stretch current federal dollars and keep CHIP running longer in a must-pass budget bill due by Friday.
Graves said other stop-gap measures might be needed before lawmakers in the House and Senate can get on the same page but said he and other lawmakers don't want states to end up "with their backs against a wall" and funds running dry.
"We're going to keep pushing for reauthorization knowing that it's important to Louisiana," Graves said.
Cassidy and Graves said the flurry of year-end spending deals might actually make breaking the CHIP deadlock easier. As leaders from both parties strike sweeping deals on spending, Cassidy said, solutions to smaller budget debates like those over CHIP become easier to find.
"There's going to be a big package at the end of the year and I suspect it might be part of that," said Cassidy. "I'll certainly support that — I know how important the program is."
Several congressional sources said the coming days might provide more clarity on the future of CHIP, as GOP and Democratic leaders work out year-end budget bargains and work to avert a potential government shutdown.
"Surely before Christmas — it has to be," said Abraham. "I feel very confident that it will get done."