PBS高端访谈:儿童健康保险项目出现资金问题（在线收听）

Hari Sreenivasan: Children's Health Insurance Program or CHIP was put into place in 1997 to provide health insurance to children families that make too much money to qualify for Medicaid but not enough to afford it on their own. Last year alone, nearly 9 million children were enrolled. Politically speaking, the program has always received bipartisan support. But this September, federal funding for the program ran out and there's no agreement yet on Capitol Hill to find the approximately 14 billion dollars a year it costs to run it. That leaves states who administer the program running out of funds and children with uncertain health insurance coverage as the end of the year approaches. Joining me now from Washington D.C. to discuss this is Diane Rowland executive vice president of the Kaiser Family Foundation. Rowland also advised Congress as the inaugural chair of the congressionally authorized Medicaid and CHIP payment and access commission. So put this in perspective for us. Has this ever been in as much trouble or uncertainty before?

Diane Rowland: This is the most uncertain time in Chip's long history. It's always been reauthorized sometimes there's been a debate about how long it should be reauthorized for but it was considered to be a slam dunk.

Hari Sreenivasan: Well what's at the crux of the disagreement?

Diane Rowland: The crux of the disagreement has mostly been about timing to begin with. It was always that they were going to first do the ACA repeal and replace law and they would get to CHIP. Now it's mostly a problem that the House and Senate have differed on how to pay for the bill. The House has made some provisions that reduce some Medicare spending and other things to help offset the cost of CHIP. The Senate has not yet passed any of the pay. So now they're arguing but mostly it's also that very little attention has been put on a priority of getting this bill done.

Hari Sreenivasan: What happens in the meantime? I mean states – some of them are kind of already over their budgets as the end of the year approaches?

Diane Rowland: Well, right now the Health and Human Services Department is trying to put out some of the unexpended funds from prior years to patch together a few of the states programs. But we know that 16 states will run out of funding by the end of January. And many of them are in the difficult position of trying to figure out whether to send a bad letter at the holiday time to families to say you ought to be prepared for us to have to terminate the program and to find other sources of coverage. Some are trying to figure out if they can get their legislatures to deal with additional appropriations to cover it with state funds. But I think everyone's hoping that the Congress will finally move to get this program with universal support enacted and on its way back to covering millions of children.

Hari Sreenivasan: So some states have already sent out those letters I think Texas is one. So what happens to these families in the interim when they're trying to figure out what's going to happen next quarter or whatever especially if they have children who have long term treatments?

Diane Rowland: Well the real problem here is that the reason CHIP exists is that health insurance coverage for many working families of moderate means is unaffordable. And even if they are offered coverage through their workplace, they may not be able to afford that coverage when it comes to full family coverage. So a lot of families are going to be very confused about what to do to get their children coverage, about where they can find affordable coverage. Some of them may try to get coverage through the marketplace but that may not be available to them if they're working for an employer that offers coverage. And for others, they're going to have to really try and look at having their children uninsured.