Jason Westin And The Children’s Health Insurance Program

Last year Blue America looked carefully at the race in the west Houston congressional district held by Paul Ryan rubber stamp John Culberson. The district, which went from a pretty red area with a PVI of R+13 in 2015 voted 48.5% to 47.1% for Clinton (after giving Romney a 59.9-38.6% win over Obama) and now has a more manageable R+7 PVI. There's more than one good candidate running for the nomination to take on Culberson but the best candidate with the best chance of beating Culberson in the general election is award-winning cancer researcher and doctor Jason Westin. Blue America endorsed him. Today we asked him to give us his perspective on the GOP sabotage of the Children’s Health Insurance Program (CHIP). Technically, Paul Ryan and his rubber stamps like Culberson have allowed the funding for the crucial program-- crucial for millions of children and their families-- to expire in September. Now states-- Connecticut and Colorado were the first two-- are starting to inform families there is no more money left for treatment. A new Congressional Budget Office report shows it would be effectively cost-free to fund the program for the next decade and Ryan has still done nothing. By the end of February half the states in the country will have no more money for the program unless Congress acts.

Please take a look at Dr. Westin's guest post below. The Take Back Texas ActBlue thermometer on the right is a simple way you can contribute to Jason's grassroots campaign. You'll find him-- and other progressives-- running in Texas this year. Even $5 and $10 contributions add up and help beat back the corporate flood of money that has kept characters like Culberson in office and serving the interests of the corporations and wealthy families who have subsidized his political career for years. Jason is running a grassroots campaign. Last cycle, Culberson spent $1,193,411 to defeat a conservative oily Democrat, James Cargas, who is running again and who spent just $62,159. This cycle a very different race is shaping up and, besides Culberson, 4 Democrats have already raised over $100,000. Dr. Westin has raised $261,590 compared to Culberson's $640,744. In a wave election, challengers don't need to raise as much as the incumbent but they do need enough money to effectively get out their message. Please consider tapping on that thermometer and doing what you can.




Medicaid Work Requirement And CHIP
-by Dr. Jason Westin

Why are Mr. Trump the GOP allowing states to require a job to receive Medicaid? Because they are "all in" that healthcare is a privilege-- there is no other explanation. They are wrong. I learned in my first days in medical school that Healthcare is a human right.

Almost 20 years ago during medical school, I volunteered at and eventually helped lead the Equal Access Clinic, a student run center to give care to those who had no access. Most were hard working people who knew they were sick, but could not afford care. Those who did not work were unable due to mental or physical illness. There were no people seeing us because they were lazy or trying to "game the system." They came to us for help, because they knew if they didn't get care, eventually they'd get really sick and end up in the ER or worse. They were constantly fearful of what would happen next, and if they'd be able to support their family.

When we helped them with blood pressure or diabetes meds, they were so grateful, I can still see their smiles almost 20 years later. The medications we gave them were helpful, but the true reason for their gratitude was being seen by another human being as worthy, that someone cared. They walked around everyday knowing they were a ticking time bomb and that no one would help them-- and that takes a real toll on how you perceive your own worth. It hardens people-- it makes them withdraw. When we reached out and said "you matter to me," they could barely contain their joy.

The idea that people who need Medicaid are freeloaders is a common misconception. The majority of Medicaid recipients work but don't have healthcare benefits or earn so little that they still qualify.

For the few on Medicaid who aren't working, almost all have a valid reason. Those who don't have a reason listed are only 3%, not of the total, but of the 40% who aren't working. That's right-- we're talking about 1.2% of Medicaid recipients.

This is the target of this rule change, 1.2%. Seriously. If that's all they are targeting, why make a big deal of this? Because the consequences will be widespread. Studies show Medicaid expansion actually reduced the number of unemployed. By making it harder to get access, this will backfire and result in more people falling through the cracks. Their approach is backward, and is clearly aimed at reducing the size of Medicaid not by helping people get to work, but by deeming them ineligible.

How could this play out? An example: A 45 year old mother of three has bad asthma. She needs medication to avoid a crisis and so she can work. If she loses her job, she wouldn't qualify for Medicaid as she would be hard pressed to prove she isn't able bodied, she just had a job! Thus, she and her family would be stuck in a spiral. Too well to be "ill or disabled," but too sick to actually work. This is what "health care is a privilege" can do.

Another example of "health care is a privilege" is the debate over the Children's Health Insurance Plan, or CHIP. I'm running for Congress against the vulnerable John Culberson in TX-07. Mr. Culberson has a lot of dangerous opinions, but it surprised even me to learn that he refuses to support insurance for 9 million poor children. Does he want them to work?

It comes down to this: Does America believe healthcare is a right or a privilege? Are we ok with allowing preventable deaths and kids to go without care? I'm not. I'm running for Congress to fight back for people like my patients.

How can we do that? I believe that a single payer system like Medicare for all is the best way for us to fulfill that healthcare as a human right. The system we have now has been cobbled together with no clear organization, like building a car by designing one part at a time. It’s not a surprise that some parts just don’t work well with the others. When there is no overall strategy, you’re just making the best of a bad situation. The Affordable Care Act tried to improve some of the parts that were most in need of repairs, but it wasn’t able to guarantee coverage, and now without the individual mandate it’s weakened further still. The Gallup poll asked "do you think it is the responsibility of the federal government to make sure all Americans have healthcare coverage?" For the past three years, the majority said that it is the responsibility of the government-- and that position keeps gaining strength. In 2017, 56% said yes vs. 42% that said no. This is clear: The American people are increasingly coming to support my core belief: Healthcare is a human right, and that the only way we can fulfill this obligation is with a single payer system like Medicare for all.

These attacks by Trump and his enablers in Congress on earned benefits like Medicaid and on innocent children with CHIP show what they believe: healthcare is a privilege. Candidate Trump said he wouldn’t let people "die on the streets" if elected-- and Ted Cruz mocked him for that position. Sadly but not surprisingly, after the election Mr. Trump has seemingly moved away from this pledge. We can do better than their heartless approach, and by electing people who know these issues first hand, we will.

I’ve gotten so mad about this attack on our care that I’ve decided to do something about it. I’m running for Congress to fight back for people like my patients. I’m in a flappable district running against a Trump Rubber Stamp named John Culberson. I can actually win, and make a real difference for our healthcare system. But many have asked-- don't we need you to fight cancer? Wouldn't we be wasting your talents in DC? I can do so much more for my patients, for healthcare, in Congress than in the clinic. When I take care of a patient, they receive benefit, but it doesn't help anyone else. When I write a clinical trial, if it succeeds I can help thousands of people by developing a new treatment. In Congress, I could help millions.

Republican Governance Has Come To Mean Dysfunction And Failure

The GOP is a natural opposition party but they have so degenerated over the last few decades that they are not a governing party. They can't get anything done at all-- not even the most basic and simple things. The congressional party is so twisted and torn by divergent ideological strains that something as simple as reauthorizing children's health care programs bogs down in the self-serving insanity that is causing more and more members of Congress to throw up their hands and retire early. In fact, that's exactly what happened this year with weak and hapless idiots like Paul Ryan and Kevin McCarthy in charge of House Republicans. This is the most dysfunctional Congress I have ever seen-- ever.

Friday, the Denver Post explained to their readers what GOP control of Congress is doing to wreck a successful and well-functioning, bipartisan children's health program and how it is impacting children's health. The story is a national one that is-- or will soon be-- impacting every state in the union. The 11 states that will be hit before the New Year are both red states and blue states: Connecticut, Pennsylvania, Ohio, Mississippi, Idaho, Nevada, Utah, Arizona, Oregon, California and Hawaii.

Officials in nearly a dozen states are preparing to notify families that a crucial health insurance program for low-income children is running out of money for the first time since its creation two decades ago, putting coverage for many at risk by the end of the year.

Congress missed a Sept. 30 deadline to extend funding for CHIP, as the Children’s Health Insurance Program is known. Nearly 9 million youngsters and 370,000 pregnant women nationwide receive care because of it.

Many states have enough money to keep their individual programs afloat for at least a few months, but five could run out in late December if lawmakers do not act. Others will start to exhaust resources the following month.

The looming crunch, which comes despite CHIP’s enduring popularity and bipartisan support on Capitol Hill, has dismayed children’s health advocates.

“We are very concerned, and the reason is that Congress hasn’t shown a strong ability to get stuff done,” said Bruce Lesley, president of Washington, D.C.-based First Focus, a child and family advocacy organization. “And the administration is completely out, has not even uttered a syllable on the issue. How this gets resolved is really unclear, and states are beginning to hit deadlines.”

Others paying close attention to the issue remain hopeful that Congress will extend funding before January, but states say they cannot rest on hope.

“Everybody is still waiting and thinking Congress is going to act, and they probably will, but you can’t run a health-care program that way,” said Linda Nablo, chief deputy director at Virginia’s Department of Medical Assistance Services. “You can’t say ‘probably’ everything is going to be all right.”

Most CHIP families, who earn too much for Medicaid but too little to afford private insurance, are not aware lawmakers’ inaction is endangering coverage. They’re about to find out, though. Virginia and several other states are preparing letters to go out as early as Monday warning families their children’s insurance may be taken away.

The Centers for Medicare and Medicaid Services (CMS), which administers the program at the federal level, issued a notice to state health officials on Nov. 9 detailing their options if CHIP funding does run dry. States forced to end the program will need to determine whether enrolled children are eligible for Medicaid or whether their family will need to seek insurance through an Affordable Care Act marketplace, the guidance said.

Longtime physician William Rees remembers the years before CHIP’s safety net, when families without coverage would put off bringing a sick child to the doctor until symptoms were so severe they would end up in a hospital emergency room.

“Pediatrics is mostly preventive medicine, it’s so important what we do,” said Rees, who has practiced in Northern Virginia since 1975. “It’s about trying to keep up with routine visits. If (children) don’t have insurance, that often doesn’t happen, so CHIP keeps them in the system and they get their vaccines when they’re due.”

The program, which is credited with helping to bring the rate of uninsured children to a record low of 4.5 percent, has been reauthorized several times over the years. And under the ACA, the federal government sharply boosted its match rate. It now provides 88 percent or more of every state’s CHIP costs.

Congress has been unable to agree on how to pay for the $15 billion program moving forward, however. President Donald Trump’s 2018 budget proposed to cut billions from CHIP over two years and limit eligibility for federal matching funds.

The uncertainty has states scrambling. Arizona, California, Minnesota, Ohio, Oregon and the District of Columbia will run out of CHIP money by Dec. 31, according to Georgetown University’s Center on Children and Families. At least six more plan to take some sort of action to address the potential funding loss, including notifying parents their children are at risk of losing coverage.

Some states operate CHIP as an independent program and would have to shut theirs down if federal dollars dry up. In Virginia, resources are expected to be exhausted by late January. Nablo said she has no choice but to send notices Dec. 1 to the families of the 66,000 children and 1,100 pregnant women in the state who are covered.

“We don’t want to act too fast if Congress is going to restore this, but we also want to give families enough time,” she said. “We have kids in the middle of cancer treatment, pregnant women in the middle of prenatal care.”

Texas plans to notify families in January that the program could end. Funding problems there were exacerbated by Hurricane Harvey because the state asked the federal government that it be allowed to waive co-pays and enrollment fees for CHIP children in counties declared disaster areas. With less money coming in, funds could be exhausted even sooner than the state first projected, according to Christine Mann, spokeswoman for the Texas Health and Human Services Commission.

In West Virginia, where CHIP funds are expected to run out in March, officials overseeing the program voted this month to shut it down Feb. 28 if Congress hasn’t acted.

Other states, including Maryland, developed their CHIP program as an extension of Medicaid and so are required by law to find a way to keep it going. The same applies to the District, which will need to come up with as much as $12.5 million in local funds to cover the approximately 14,000 children enrolled, the D.C. Department of Health Care Finance said. The agency will begin looking next month at where money can be diverted.

“It’s pretty chaotic out there,” said Joan Alker, executive director at the Georgetown center. “What really troubles me about it is (CHIP) is successful. Everyone should feel good about it. There’s no reason for this to be lagging on like this. This should be an easy win for Congress.”

CHIP has become a political issue in the gubernatorial race in Maryland, where funding would run out in March. Gov. Larry Hogan, R, has pressed for Congress to pass a reauthorization. A potential Democratic opponent, Ben Jealous, has criticized him for not having a backup plan to protect the 140,000 children who would be left uninsured.

In Washington, lawmakers in both parties agree on the program’s merits but are at an impasse over how to pay for it. The House passed a bill this month along largely party lines to extend CHIP funding for five years in part by cutting an ACA prevention fund and raising Medicare rates for wealthier seniors.

That measure unlikely to be taken up by the other chamber. Senators, led by Finance Committee Chairman Orrin G. Hatch, R-Utah, are working to find a bipartisan solution. Hatch was one of the authors of the original CHIP legislation in 1997. The other was Sen. Edward M. Kennedy, D-Mass., who died in 2009.

“I am working with my colleagues to advance this bill in a fiscally responsible manner so we can ensure coverage is maintained,” Hatch said in a recent statement. Yet during a heated exchange last week in a committee meeting on the GOP tax overhaul, he voiced little urgency.

Back up your concern for the poor by starting with an extension for CHIP, Sen. Sherrod Brown, D-Ohio, told Hatch.

Hatch responded angrily, “I’m not starting with CHIP.”

Andy Slavitt, who was acting CMS administrator under President Barack Obama, can’t believe there is anything to debate. That Congress would hold up popular legislation that has never before been subject to politics speaks to the “very fragmented culture of lawmaking,” he said.

“It’s a core program that many low-income families rely on. It’s widely acclaimed to be a success,” he said. “We’re operating in a mode that we don’t do anything until it’s an absolute crisis, and we’re creating more crises that don’t need to happen.”

When Congress failed to extend funding in late September, CMS was able to provide several states and U.S. territories with emergency money to keep their programs going a bit longer. The agency has used about $542 million in leftover funds from previous years, but it has limited resources to assist much longer.

Paul Clements, the progressive Democrat running for the southwest Michigan seat help since 1986 by hereditary multimillionaire Fred Upton, is, like most Americans, angry at all the GOP dysfunction. "It's disgraceful that Congressional Republicans can agree to end the estate tax for individuals with assets from $5 million to $10 million but can’t agree to extend health insurance for children in low-income families. In Michigan, besides covering preventive and curative care for children, the CHIP program also provides insurance for young people who drank lead-contaminated water from Flint, as well as pregnant women who drank this water and children born to them. This program has traditionally had bipartisan support, but now, to pay for it, Congressman Fred Upton and other House Republicans want to cut public health funds from the Affordable Care Act, among other programs-- a highly partisan move. This is one more example of Upton and his party neglecting the needs of vulnerable citizens, even children made vulnerable by government failure to maintain water quality, while working hard to further enrich our wealthiest citizens."

Upton is part of Ryan's inner leadership team; and so is Virginia Foxx, an especially reactionary and bigoted congresswoman for North Carolina, another multimillionaire out of touch with what her middle class constituents expect from Congress and their government. School teacher Jenny Marshall is the savvy progressive opponent standing up to Foxx and Ryan. She told us that while Foxx "voted yes to the last House bill on CHIP (H.R.3922) it was only because there were billions of dollars in other public health funding cuts. Rep. Foxx has voted no to the reauthorization of CHIP every chance it has come up. There are 100,000 children who rely on CHIP and another 130,000 that rely on Medicaid expansion of CHIP. Taking medical insurance away from needy children is a blow to working families who are struggling to survive. I believe that healthcare is a human right. We should be finding ways to expand the program to provide more coverage, not less. This is even more timely as we are seeing House and Senate Republicans give a huge tax break for the wealthiest in our country. We cannot continue to ignore the needs of our neighbors. We cannot dismiss the majorities' rights to life, liberty and the pursuit of happiness relegating it only to the ones who can afford it. We must reauthorize CHIP and begin to invest in our communities for a future we all can believe in."

David Gill is the progressive running for the Democratic nomination to oppose Ryan puppet Rodney Davis. He got right to the point: "It sickens me to watch Rodney Davis and the rest of Republicans fail to act regarding the funding of children's healthcare at the same time that they fall all over themselves to give huge tax breaks to the wealthiest in society. I provide care to dozens of children each week in the Emergency Department, where I bear witness the to failures that already exist within our current system. It's beyond shameful that these children will have even further difficulty finding healthcare, through no doing of their own. There are many reasons why I look forward to handily defeating Mr. Davis in next November's election, but this punitive treatment of innocent children ranks among the highest."