Scott Gottlieb of the American Enterprise Institute highlights an issue that may have escaped notice to this point: under Obamacare, children enrolled in the Children’s Health Insurance Program are going to be shifted around whether they want to be or not. For them, Medicaid is mandatory.
CHIP has plenty of flaws. It has increased the cost of coverage by limiting competition in the insurance market. But it can give kids a choice of private health plan models that are a lot better than traditional Medicaid. Right now, many states benchmark the benefits that CHIP must offer to the same standard Blue Cross/Blue Shield plan that’s available to Members of Congress in the Federal Employees Health Benefits Plan (FEHBP), or to the benefits offered to state workers, or to the most popular private health plan that’s already operating in a particular state.
Under Obamacare, any kid whose parents earn between 100% and 133% of the Federal Poverty Level (FPL) will be forcibly moved off of CHIP and into Medicaid. That comes out to families of four earning $23,000 to $31,000 in annual income. It ropes in thousands of children. And it will unfold regardless of whether a particular state plans to expand its Medicaid program for adults to meet the 133% threshold.
It’s all part of the President’s vaunted Medicaid expansion and an obscure provision buried in Obamacare. When the feds coaxed states to expand their Medicaid programs up to 133% of FPL, they wanted to make sure that kids followed their parents into the program (presumably so that families would be covered under the same insurance schemes, making managed care easier). So section 2001(a)(5)(B) of Obamacare made the children whose parents earned between 100% and 133% of FPL (based on their parents’ modified adjusted gross income) a “mandatory” Medicaid population. (Of note: states will retain their ability to claim the enhanced CHIP matching rate out of their CHIP allotments for this population).
But this provision is separate from the language that offers states enhanced matching funds to expand their overall Medicaid programs up to 133% of FPL. That means that the impact on the CHIP kids will take effect regardless of what the states choose to do with the rest of their program. It’s also not affected by the Supreme Court decision that gave states some flexibility to refuse the Federal Medicaid expansion.
Considering how poor Medicaid’s outcomes are for kids, particularly in the area of dental health – a critical issue for youngsters – this is another example of how ill-thought Obamacare’s mandates are.