Congress Health Overhaul

FILE - In this Feb. 17, 2017 file photo, the Capitol is seen at sunup in Washington.(AP Photo/J. Scott Applewhite, File) 

J. Scott Applewhite

WASHINGTON — A popular federal program that provides health care for low-income children and pregnant women has found itself trapped in legislative limbo on Capitol Hill, with lawmakers locked in a partisan battle over just how to pay for it.

The lapsed Children’s Health Insurance Program, which covers roughly 9 million low-income children and expecting mothers nationwide and about 121,000 kids in Louisiana, saw its congressional authorization expire on Sept. 30. Although the program enjoys widespread bipartisan support, a bitter fight over cuts to help pay for it has pitted Democrats against Republicans.

No one covered under the program has lost insurance coverage yet, as most states still have enough federal funds to keep it running for several more months. But the deadlock has state officials, including those at the Louisiana Department of Health, drafting up notices for enrolled families about possible coverage losses.

Andrew Tuozzolo, chief of staff at the state Department of Health, said about 6,300 children covered by the program in the state would be at risk of losing coverage altogether when the state’s federal CHIP funds run out in February. Others covered by the program likely would continue to receive coverage without a reauthorization — but only by shifting millions of dollars away from other state health programs, Tuozzolo said.

The state would need to pick up an additional $31 million tab for 2018 and find more than $112 million more for each year afterward, Tuozzolo said.

Lawmakers in Washington have offered assurances it won’t come to that, with Congress relying on the cushion offered by rollover federal CHIP funds to allow negotiations to drag on. Funding for local clinics known as federally qualified health centers is also wrapped up in the CHIP bill.

Yet there was little indication last week that a compromise ending the standoff was in the immediate offing.

A Friday vote in the U.S. House of Representatives to renew the program, passed largely along party lines, is unlikely to become law. It faces dim prospects in the U.S. Senate, where Republicans hold a much narrower majority and need at least a handful of Democrats to sign onto legislation.

The GOP-backed House bill would pay for parts of the program largely by dipping into a preventative health program set up under the Affordable Care Act — a move staunchly opposed by most Democrats — and by cutting some Medicare funding for high-earning seniors.

The bill passed the House easily, 242 to 174, on a vote that broke down largely on party lines. Louisiana’s five Republicans — Reps. Garret Graves, of Baton Rouge; Steve Scalise, of Jefferson; Clay Higgins, of Port Barre; Ralph Abraham, of Alto; and Mike Johnson, of Bossier — all backed the bill. The state’s lone Democrat in Congress, Rep. Cedric Richmond, of New Orleans, voted against it.

“I’m glad to see the House pass measures that reauthorize and extend both programs in a fiscally responsible manner that protects taxpayer dollars while prioritizing health care for the most vulnerable Americans,” said Higgins, a freshman congressman whose district includes most of Acadiana and Lake Charles.

“Healthcare is not a zero-sum game. You don’t have to take healthcare away from some in order to give it to others,” said Richmond, the chairman of the Congressional Black Caucus, in a statement explaining his vote on a program he otherwise supports. “Instead of doing what is right, Republicans would rather play politics with a federal program that millions of children rely on, including 120,000 in my home state of Louisiana.”

Republicans, meanwhile, described their proposal as “fiscally responsible” steps to continue funding for the program. During heated debate on the House floor before Friday’s vote, members of the two parties sought to place blame for the program’s expiration on each other.

“I have tried for months to negotiate with Republicans to develop a bipartisan compromise,” said Rep. Frank Pallone Jr., D-N.J. “But House Republicans chose to spend the first nine months of this year trying to repeal the Affordable Care Act. They failed, but now House Republicans are using the reauthorization of CHIP and Community Health Centers as a way to once again sabotage the ACA.”

Rep. Greg Walden, R-Ore., the bill's primary author, complained that Democrats' opposition amounted to "delay, delay, delay and vote against kids, vote against their hospitals and vote against their doctors."

In the Senate, a bipartisan bill backed by Sen. Orrin Hatch, R-Utah, and Sen. Ron Wyden, D-Ore., passed out of committee but is awaiting a vote on the Senate floor, with lawmakers there still divided over how to fund the program’s extension.

Several House Democrats warned before Friday’s vote that the House bill almost certainly would die in the Senate, ensuring further delays in reauthorizing the program.

Many on Capitol Hill now expect an eventual compromise on financing the children’s health care program to wind up being tacked onto a broad, high-stakes funding bill required to pass by early December to avoid a federal government shutdown. A host of other tricky political deals appear set to wind up tied to that spending bill as well.

Louisiana’s two senators — Bill Cassidy, R-Baton Rouge, and John Kennedy, R-Madisonville — both brushed off concerns over the program's reauthorization and expressed confidence that Congress would work out a deal on the program before states begin running out of cash to pay for the coverage.

Eleven states, including Mississippi, are projected to run out of CHIP funds before the end of the year, though some federal officials have indicated dollars could be shifted between federal programs to stretch those states into the new year.

“I realize the importance of CHIP to children across Louisiana,” Kennedy said. “I am confident that the Senate will reauthorize funding for this vital program in the coming weeks.”

Cassidy, a member of the Senate Finance Committee, backed the Hatch-Wyden bill and said he’s working in the Senate to get the program reauthorized before children end up losing coverage.

Cassidy had repeatedly touted the program’s bipartisan support while trying to sell Senate colleagues in September on the Cassidy-Graham health care bill that would’ve repealed much of the Affordable Care Act and shifted its funds into massive block grants for states.

Critics of the bill had raised questions over provisions in the Cassidy-Graham bill that slated those block grants to expire after 10 years without congressional action. Cassidy pointed to the ease with which Congress has extended CHIP in the past to calm concerns over that part of his health insurance proposal, which ultimately failed.

Cassidy, asked in late October about the CHIP's expiration and the ongoing negotiations over the program, indicated he saw little reason to worry about congressional inaction.

“I don’t think this is necessarily rough,” Cassidy said of negotiations. “There’s money in states to continue the program and CHIP will be reauthorized, I can promise you that.” 

Follow Bryn Stole on Twitter, @BrynStole.