WASHINGTON -- The final implementation of the Affordable Care Act (ACA) could be bad news for re-authorization of the Children's Health Insurance Program (CHIP), a congressional staffer said.
"There's a very legitimate fight to be had over whether or not we should even have CHIP anymore," Rodney Whitlock, director of health policy for Sen. Chuck Grassley (R-Iowa), said at the Pediatric Academic Societies (PAS) annual meeting. "Because if you've got private coverage, federally subsidized tax credits for coverage for people above 133% [of the federal poverty level], then why do you have the CHIP program?"
"And that conversation is going to continue to happen until there's a general consensus that we can move forward," Whitlock told 51˶.
Authorization for the program, which provides health coverage to families who make too much to qualify for Medicaid but too little to afford costly health insurance, expires at the end of September 2013.
But it remains to be seen how CHIP will work with the ACA. President Obama's 2010 health law sought to expand Medicaid coverage for those living up to 133% of poverty, while providing tax credits for those who don't quality for expanded Medicaid and make up to 400% of poverty.
During debate over the ACA, many members of Congress argued CHIP would be unnecessary. The program wasn't included in a version that passed the House, but was part of the Senate bill that ultimately passed and was signed into law.
Roughly three-fourths of the 7 million children who were uninsured in 2009 will be eligible for health insurance under the ACA, the Government Accountability Office reported last summer.
CHIP won't completely disappear after its current 4-year authorization ends on September 30. Instead, the program will just revert back to previous year's funding levels and lawmakers will have an opportunity to wait for the ACA to fully come online and reassess the program.
"We will see particularly what we think is most appropriate for children and what is our mechanism for getting parents to engage, to get coverage for their children, and [for children] to be seen and receive care," Whitlock said at a wide-ranging PAS panel on current legislative issues affecting healthcare.
CHIP was one of many notable topics discussed at the session.
Oversight of Compounding Pharmacies
Lawmakers hope to pass a bill that provides the FDA with greater authority over certain compounding pharmacies that act like small manufacturers by Memorial Day, said Sara Singleton, legislative assistant for Sen. Tom Harkin (D-Iowa).
Harkin, chair of the Senate Health, Education, Labor, and Pension (HELP) Committee has pushed for such a law after last fall's fungal meningitis outbreak from tainted steroids produced by the New England Compounding Center. The FDA says its authority over compounders has been unclear and contested.
However, lawmakers in the House have been less supportive of such a bill, saying the FDA had all the authority it needed to prevent such an outbreak. However, Singleton didn't directly address this discrepancy.
"We hope that since it's a bipartisan product that we will have some success in moving it forward," Singleton said.
Mental Health Awareness
The Senate recently passed the Mental Health Awareness and Improvement Act by a 97-2 vote, and Singleton said she's "hopeful" it'll move forward.
The bill, among other things, supports youth suicide prevention programs, increases mental health awareness training for school and emergency services personnel, and expands the reporting of certain data to help suicide prevention strategies.
The deadly shootings in Newtown, Conn. provided an opportunity to look at mental health programs, she added.
The Substance Abuse and Mental Health Services Administration was last reauthorized by Congress in 2000. "It's been a long time since we touched a lot of those programs," Singleton said.
Increasing Provider Workforce
Singleton also noted the HELP Committee would continue to look at provider workforce issues as the ACA swings into full force next year, adding it's a "challenge" to address this.
"We've known for a long time that we don't have the workforce that we need, and that problem is growing," Singleton said. "It's not an easy one to solve and an expensive one to solve, and money is tight these days."