Health Insurance

CHIL’s Guide to Community Health Clinics

In CHIL’s blog post last week, we mentioned Mary’s Center, a community health clinic in Washington D.C. This week, we want to emphasize that clinics like this one are available all over the nation. In fact, there are about 1,400 community health clinics (CHCs) in the U.S. While undocumented immigrants and Dreamers are ineligible to enroll in the federally-subsidized health insurance plans provided via the Affordable Care Act, CHCs often offer a good alternative for anyone seeking affordable health care—both citizens and non-citizens alike.

Additionally, these clinics do not operate under any low-income or insurance coverage eligibility requirements; that is, a family with a working parent covered by some form of health insurance is welcome at places like Mary’s Center, too. Medical costs in the United States’ largely privatized system indeed can be overwhelmingly burdensome, even for people with steady employment.

So, how do CHCs operate? What services do they provide for individuals and families, and at what cost?

CHCs are nonprofits that receive funding from a myriad of sources including federal, state, or local grants and/or Medicaid payments. Some may partially rely on private funding sources as well. Because several institutions finance each CHC, in most cases, this provides the centers with a safety net. If one funding source is compromised—something common in the U.S. as administrations shift—CHCs have other means to remain afloat.

In order to qualify for public funds, CHCs must:

  • Be located in a medically underserved area or serve medically underserved populations (determined by the federal government)

  • Provide comprehensive primary care

  • Adjust fees according to a sliding scale based on patient income

  • Be governed by a community board, of which at least 51% of members are patients of the CHC themselves

Apart from providing comprehensive primary care, CHCs may address local needs like care in foreign languages or medical translators (for which their local community board can advocate). Another example is Mary’s Center partnership with Briya Public Charter School. Briya holds classes at Mary’s Center, providing an educational space for both parents and their children. Briya’s model works well for teenage parents who otherwise may have had to forgo public education. They also offer a counseling and educational group for (future) parents to attend throughout pregnancy; a program called "centering." These two programs are particularly useful for the areas Mary’s Center serves, where there are many young families.

The localized care many CHCs provides sets them apart from other medical facilities and makes them integral to the health of thousands of children living in the U.S. today, particularly living in vulnerable and underprivileged families. If you or your kids are in need of affordable health care, CHIL recommends looking into your local CHCs for medical services. This search tool can help: https://findahealthcenter.hrsa.gov/.

CHIP CHIP Hooray!

Last week was an exciting one for children’s health. After a harrowing few months of uncertainty over the fate of the Children’s Health Insurance Program (CHIP) — the very important federal children’s health insurance program which covers about 9 million children nationwide — Congress agreed to reauthorize CHIP for another six years. You can read about this fantastic news here at NPR.  

 

We will continue to monitor this big news to examine more closely what this means for children’s health and access in the immediate future. The past few months should have taught us that we should not take the program for granted. After all, the fact that CHIP — an “uncontroversial” program throughout its 20-year history — faced such an existential crisis is an indication of our current political climate. According to NPR, CHIP, which needs to be renewed every few years, was historically a bipartisan priority that legislators worked to renew far in advance. Researchers are still working on finding the impacts of children’s enrollment rates with CHIP within these months of uncertainty.

 

Some analysts say that extending CHIP for 10 years instead of six would save the federal government much more money, but this deal is still a solid one. Also, one analyst suggested that the national anxiety over CHIP might have brought more attention to it in the long run. More people can now be aware of the program and what it does (and possibly be encouraged to enroll), and more people can communicate to lawmakers about the importance of keeping the program alive. States can also start brainstorming safeguards for future use, just in case we are faced with a similar situation in the future. The role of states is especially important since CHIP is based on an architecture of shared responsibility between the states and the federal government.

 

CHIP is the sort of program that we may not have heard enough about if not for events such as the most recent budget crisis. It is, however, a very important source of health insurance for many American children. On his show, host Jimmy Kimmel explains a bit more about CHIL and its significance to his family. As we celebrate the most recent news, we should look ahead and start planning for CHIP’s future, so that we don’t repeat history.

A Follow-Up on the Children’s Health Insurance Program

The NYTimes reports that a bill to refinance CHIP, the popular children’s health insurance program we discussed in a previous blog post, has moved from the Senate to the House of Representatives, only to get stuck in the latter. If this bill survives partisan gridlock, then its provisions would set aside more than $100 billion over the next five years for the nearly nine million children enrolled in this program.

 

Although the main architects of the Senate bill hailed it as a “prime example of what government can accomplish when both parties work together,” there are still many points of contention between Republicans and Democrats when it comes to healthcare spending. The only thing they seem to be able to agree on at the moment is the urgency of the situation.

 

Federal funding for CHIP expired a few days ago, and apparently, there is no way to predict when a bill might be ready to move on to the White House. Several states have already tapped into emergency federal provisions in order to offset spending while Congress deliberates. Three states are scheduled to run out of CHIP funds at the end of this year, and a total of 30 states will be out of cash by March 2018.

Children's Health Insurance: Legislation and Impact Today

On September 30th, the Children’s Health Insurance Program (CHIP) will be up for renewal in Congress, according to NPR. This “popular federal state-program” provides health insurance for more than 9 million children of families who may otherwise be unable to afford health care.

 

Some health experts fear that CHIP’s deadline will fall by the wayside while Congress deals with urgent matters in providing relief for Hurricanes Harvey and Irma. In addition, they also fear that fierce division within Congress and budget-related government shutdowns could push CHIP down the priority list. As a result, states would be left with no choice but to start scaling down the reach of CHIP, leaving many children without health insurance at a point in their lives when regular healthcare is crucial.

 

Among the multiple reasons for the importance of CHIP, one that stands out is the population of children it affects the most. The children who currently benefit from this program come from families who are in lower- or middle-income brackets but do not qualify for Medicaid. As a result, they may be forced to pay more medical bills out of pocket, increasing health and economic insecurities among this population.

 

Since its adoption in 1997, CHIP has enjoyed bipartisan support, and has been a big factor in the reduction of uninsured children from 13.9 percent in 1997 to 4.5 percent in 2015. Its impact is universally acknowledged, but up for immediate debate are the enhancements the 2010 Affordable Care Act added to CHIP. The ACA increased federal spending for CHIP by 23 percentage points, but “forbid states to restrict eligibility rules.” However, like the ACA as a whole, these enhancements may be changed in the near future.

 

The need to renew and secure CHIP’s future is urgent. Without congressional action, several states could run out of CHIP funding as soon as next year. While CHIP could be reauthorized “with no strings attached,” its uncertainty means that parents, health care providers, and community members should stay aware of its status. This is crucial if we believe, as we do here at CHIL, that the health of children is a bipartisan, long-term priority.

Economics, Doctors, and Us: A New Kind of Medicine?

A physician wrote a piece in the New York Times recently that is very relevant to our mission and work here at CHIL. Dr. Khullar writes that years of medical and scientific education often do not influence his decisions as much as his patients’ habits and environmental cues. If anything, a decade of diverse and intense training has made him more attuned to noticing subtle “nudges” and cues that incentivizes him to provide the best care he can, or incentivize his patients to be proactive about their health care.

 

According to Dr. Khullar, the field of behavioral economics holds that “human decision-making [often] departs” from what might be expected if agents behaved “rationally.” This description seems to characterize medical care as well, where all sorts of factors (emotions and uncertainties, for example) can complicate medical decisions. Despite this connection, Dr. Khullar says that members of the medical community have “only recently” begun exploring how behavioral economics can improve health. This is a crucial change, since medical experts bear an enormous responsibility in how they present care options to patients and how they encourage patients to pursue treatment options. For example, the framing of default options as opt-in or opt-out can have a huge impact on how healthcare is delivered to patients.

 

Pioneers in linking behavioral economics, decision-making, and medical care are focusing on designing randomized trials or applications to tackle some of the basic, and difficult, challenges in healthcare. Dr. Khullar names some of these challenges as encouraging doctors to provide evidence-based care, incentivizing patients to take their medications (a form of preventative care), and aiding consumers in choosing better health plans that were more comprehensive for their needs. Innovators are also using these challenges as opportunities to create applications to, for example, reward patients for submitting pictures of themselves taking medications each day. These designers create program infrastructures that reward patients for weight loss goals they establish by entering them into lotteries or deposit contracts. Health insurers are jumping onto this wagon as well, and researching goals for patients and doctors to meet when it comes to diseases like diabetes management.

 

The title of the New York Times piece is “How Behavioral Economics Can Produce Better Health Care.” This title leaves out some crucial actors in the study and delivery of a marriage between behavioral economics and health research. Doctors, patients, and economists each play a distinct role in identifying and acting on potential improvements in healthcare delivery. Projects like the ones we have at CHIL are designed with students as patients in mind - behavioral economics isn’t only for economists! We can all use a project-oriented approach to improve our health.

The Future of Healthcare Coverage for Children

Today we’re shifting gears a bit and talking about what the future of the Affordable Care Act (ACA) means to us and our children moving forward. Its political future has been uncertain ever since election night with no clear signals coming from the Capitol about plans to modify the landmark legislation. The “repeal and replace” rhetoric has largely been replaced with a more muted “repair Obamacare” (according to The New York Times), which doesn’t help the uncertainty we face regarding its future in our daily lives.

NPR recently published an article looking at Arizona as a case study in predicting what would happen to health insurance for children if Obamacare were to be repealed. It looked at the case of Vanessa Ramirez, a young mom of two who is an ovarian cancer survivor. She bought insurance for herself on HealthCare.gov, and her children are covered through Arizona’s KidsCare, the state’s version of the federal Children’s Health Insurance Program. Her experience of being surprised with a cancer diagnosis as an otherwise totally healthy college student is a major influence in her life and the choices she makes for her kids. 

Arizona may differ from other states in that it has one of the highest rates of uninsured children in the country and “more children enrolled in the federal marketplace than almost any other state,” according to NPR. This means that states with a high rate of children enrolled in government health insurance could be severely impacted by a repeal of the ACA. Without a solid plan in place, the number of children affected would be about 130,000 in Arizona alone. As a state, Arizona may be unique but it is not entirely unlike other states: it has a fast growing population with a significant number of people living near the poverty line.

Families like Vanessa’s will be the first to suffer if an ACA replacement does not adequately account for the hundreds of millions of dollars it will take to keep current beneficiaries on Medicaid. The ACA has brought coverage to thousands of children in Arizona in recent years. One could argue that children should be one of the most important priorities for health insurance legislation, since preventive care and annual physicals are indispensable in ensuring that children grow up healthy. Regardless of what state we live in, it is paramount that we provide health access for all children and families.