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Monthslong battle over CHIP took a toll on families, agencies

Marsha Raulerson talks with her patient, Liam Yarbrough, 6, in Brewton, Alabama. (Kevin D. Liles / Washington Post)
Marsha Raulerson talks with her patient, Liam Yarbrough, 6, in Brewton, Alabama. (Kevin D. Liles / Washington Post)
By Robert Samuels Washington Post

PRATTVILLE, Ala. – The government shutdown was over, and Varina Mead finally felt a little at ease. The single mother, 38, smiled as she watched her two children put down their backpacks, curl up under on the red couch and watch “Surf’s Up” while she prepared dinner in the kitchen.

No longer was she considering selling the Mazda to help pay for her children’s prescriptions. No longer did she consider downsizing her home to afford a trip to the doctor.

For months, as Congress held off on reauthorizing the Children’s Health Insurance Program, Mead fretted about how she’d manage if she had to buy private insurance through her nonprofit employer. She received a reprieve when President Donald Trump signed a bill to keep the program running for another six years, part of a deal to end the government shutdown.

“I live a pretty humble lifestyle and spend my days trying to better my community,” she said. “I had no line items to cut.”

The saga came with a cost. Even though no child in the country lost health-care coverage during the monthslong CHIP stalemate, the political brinkmanship left a heap of bureaucratic and psychological debris.

Its effect portends what could happen with other government programs if Congress continues without a long-term budget plan, passing temporary fix after temporary fix, while social programs continue to hang in the distance.

“There was harm and foul in this limbo period,” said Jim Carnes, policy director of Alabama Arise, a local advocacy organization. “Those who contend that there wasn’t do not appreciate the burden it put on working parents with children with health-care needs. They don’t understand how unfair the process was to say, ‘We’re going to toy around with your children’s health insurance for a while and see what comes out of it.’ ”

In Oregon, Democratic Gov. Kate Brown authorized tapping into the state’s reserve funds to keep the program going. Other states, such as Colorado and Virginia, told parents to seek other insurance options. Agencies created expensive computer programs they will never use and delayed hiring new staff they say they were really needed. And an untold number of parents bought insurance policies they couldn’t afford to help keep their children healthy.

Mead’s oldest child, Ava, is 10 years old and has asthma. Her mother began to wonder how far in advance she could stock up on inhalers when prescription costs are low. She worried about Gavin, 8, who was so jumpy he could hardly concentrate to get ready for school.

When Mead heard that CHIP funding could run out, she took a day off work to make as many appointments as she could with doctors to check on him.

“It was a mad dash against time,” she said.

In December, doctors diagnosed Gavin with attention-deficit/hyperactivity disorder and prescribed medication.

“It’s not medicine for something bad; it is good medicine,” the boy recalled his doctor saying.

Mead was grateful for the diagnosis. And then she agonized over how she could possibly pay. The enrollment period had ended to get insurance for her children on a federal marketplace created through the Affordable Care Act. With CHIP, she paid $13 dollars per doctor’s visit. With private insurance, each visit would cost $40.

With CHIP, she insured her two children for $104 a year. Without it, her premium would rise to $500 each month.

For Mead, one word would describe the impact: “Devastating.”

When Congress first authorized CHIP legislation in 1997, about one in five children in Alabama were uninsured, according to Cathy Caldwell, the state’s CHIP director. Alabama was the first state to sign on, and since then, the number of uninsured children dropped from about 20 percent to 2 percent.

CHIP subsidizes coverage for about 160,000 children in the state. About half of those children are among the state’s poorest and on Medicaid through CHIP. And 85,000 of them are in families whose income amounts to 312 percent over the poverty level at most – a salary of about $65,000 for a family of three. They make too much for Medicaid, but not enough to afford private insurance or coverage on the federal marketplace.

Because the program called for working families to pay for the insurance on a sliding scale, it was easier for conservative lawmakers in Alabama to support it than, say, food stamps or welfare, Caldwell said.

Still, local lawmakers who had lined up behind the program began worrying about its future after Republicans’ strong showing nationally in the 2016 elections, said state Rep. Steve Clouse, a Republican and chairman of the state legislature’s budget committee.

The federal government was projected to disburse more than $280 million to Alabama to fund CHIP this year, according to a nonpartisan research agency that advises Congress on the program. But attitudes in Washington were changing about fully funding programs, and state lawmakers concluded they needed to be prepared in case Congress began to ask states to contribute more, Clouse said.

So last budget season, the legislature kept $93 million in the state’s coffers to potentially soften the blow, Clouse said. If Congress had authorized CHIP funding earlier, the state would have hired more state troopers and mental-health professionals and better addressed the overcrowding of prisons, he said.

Despite persistent disagreements in Washington about how to keep funding CHIP, Clouse said he continued to receive assurances from Capitol Hill that the program would be reauthorized before it expired Sept. 30.

“Then we were told it was going to be fully funded by Thanksgiving, then it was going to be funded Christmas, then by Jan. 1,” he said. Wrong, wrong, wrong.

By winter, Caldwell in the health department issued a statement that CHIP funding was in danger of running out by December. The state planned on freezing enrollment in January and cutting 80,000 children from the program in February. Staff who had helped enroll families were reassigned to answering phone calls from concerned parents, and Caldwell delayed hiring for 10 “critical” positions, including computer analysts and a nursing coordinator.

Her department printed and stuffed about 50,000 envelopes with letters telling parents they had to find insurance for their children some other way – missives they’d eventually have to shred, wasting thousands of dollars.

“We wasted so much time,” Caldwell said. “It was the most stressful time in my entire career.”

Nine million children use the CHIP program nationally, and many of their families across the country were scrambling in the uncertainty. In Alabama, Marsha Raulerson, a pediatrician in Brewton, heard from many parents wondering how or what they could do to cope.

“They are already working long hours, doing the best they can,” she said.

Some parents contemplated working more hours to afford higher health-care costs. Others discussed quitting their jobs. This way, they could lower their income enough to qualify for Medicaid. If they couldn’t afford insurance, what was the point of working?

Congress adjourned for the holidays without extending the program long-term. Finally, Republicans attached funding for the program to a resolution to pass a budget in January.

In the wake of the debacle, advocates plan to push for making the program permanent, as opposed to one that needs periodic reauthorization.

“It’s a shame when you have to test Congress to see how low they can go, but they went pretty low this time,” Carnes said. “If you flirt with danger, you might even go even lower the next time.”

The national anxiety seized Mead. Losing insurance for her children seemed like an unfair setback after she worked diligently to rebuild her life.

She started her career more than a decade ago, drafting a curriculum for low-income households to understand the expectations that come with receiving welfare. She left that job to raise Ava and Gavin. After her husband became addicted to opioids and stole from her, she said, she found herself broke and alone.

Her neighbors and church groups pitched in to help pay her electricity bills and put a security deposit on a new house. Suddenly, she said, she found herself in a class for receiving welfare benefits using the curriculum that she wrote. She took a job cleaning houses and began her climb out of poverty.

She now rents a ranch home atop a small hill, where Gavin and Ava like to run in the forest where there’s a swing that hovers over a small ditch, and they can play with their neighbor’s dogs.

The home is about a half-hour away from her office on a gravelly highway at Easter Seals Central Alabama, which sits inside a threadbare warehouse without hot water. The organization focuses on services for the elderly and the disabled. One in five of its clients uses CHIP – just like Mead, the organization’s marketing director.

“They are trying to make this political, but it is not a political issue,” said Edie Malone, director of finance and business at Easter Seals. Her son’s two infant children use CHIP. “Everyone in Alabama knows someone who is on CHIP.”

She and Mead don’t see eye-to-eye politically. Malone is a Republican; Mead, a Democrat. They found themselves split during the heated Senate campaign between Republican Roy Moore and Democrat Doug Jones, but both felt good when Jones announced during his victory speech that restoring funding for CHIP would be one of his top priorities as a legislator.

When Ava and Gavin’s health insurance became attached to the Republicans’ budget proposal, most Democrats refused to sign on to the bill unless it also had protections for undocumented immigrants who came to the country as children. Both women were pleased that Jones sided with Republicans.

“He promised us he’d do it, so I’m glad he focused on his own people rather than people who aren’t here legally,” Malone said.

“I wish he could have gotten both,” Mead said. “But this need was more pressing.”

Still, they were unimpressed when the government ended up shutting down and lawmakers complained about something so frivolous as the lack of clean towels in the Capitol’s weight room.

“They treated my kids’ health insurance like it was a game,” Mead said.

Malone feared what other programs might hang in the balance. Their organization, for example, runs a job placement program for residents who are 55 and older that typically receives $1 million in federal money. That funding remains up in the air.

“People need these programs in their lives, for security,” Malone said. “But politicians have forgotten that.”

That evening, Mead picked up her children after school and came home. Ava and Gavin chased one another around the red couch, and Mead set up for dinner.

As the scent of chicken casserole wafted through the house, Gavin began talking about his school day. It was a little stressful. He and his friends were playing a game in which they imagined a hole was filled with snakes, but he got into a fight with one of his friends because he wasn’t following the rules. Their friendship, Gavin said, was over.

“Maybe you could talk it over with him tomorrow,” Mead suggested.

“It’s no good talking to him when he’s upset,” Gavin told her. “He just doesn’t listen.”

“Sometimes, it’s hard to get along with people,” she said. “But you still have to try.”

It was a motherly counsel she hoped could be heard in Washington.

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