A year ago this month, anxious parents and children’s advocates awaited a decision by Congress regarding the future of one of the nation’s most successful health programs. Funding for the Children’s Health Insurance Program (CHIP) – which has provided health coverage for millions of low-income children since 1997 – was in jeopardy of expiring, leaving more than eight million children in a dangerous gray area.
Without CHIP, those children who were ineligible for Medicaid but whose families could not afford private insurance, would be expected to obtain coverage through their state’s Health Insurance Marketplace. But some marketplace plans failed to offer affordable, comprehensive coverage for specific services, like dental healthcare, for children.
The disparities in care coverage were across the board – CMS found that the benefit packages in CHIP plans are generally more generous than marketplace plans for a wide range of child-specific services, including dental, vision, rehabilitation services, and for children with special health care needs.
It’s an extremely disappointing revelation for some lawmakers who had hoped marketplace plans could deliver much-needed coverage for low-income children. But it also serves as a resounding message to Congress as to why lawmakers should act to permanently reauthorize CHIP during this session.
For millions of low-income children and their families nationwide, permanent reauthorization of CHIP would mean the ongoing ability to receive essential healthcare coverage – including important preventative services – which families simply can’t afford in the marketplace.
In Louisiana, for example, families of low-income children with CHIP might expect to pay around $300 annually in cost-sharing and out-of-pocket costs for health care services. Compare that to the lowest-cost marketplace plan, and those out-of-pocket costs balloon to over $1,000 annually, in part due to high deductible. For families living at 200 percent below the federal poverty level, it’s simply not a realistic option.
As we wait again this month – National Children’s Dental Health Month – for Congress to work toward a decision in the best interest of our nation’s children, dental professionals are among the groups hopeful for permanent CHIP funding. For nearly twenty years, CHIP has allowed millions of children to access critical dental services, driving down the number of young children with tooth decay and cavities to its lowest point in 25 years. It’s had an overwhelming impact on overall health, and it has helped save healthcare dollars through prevention and education.
Research has shown that lack of early, preventative dental care – a likely scenario in the absence of CHIP – is directly linked to poor school attendance and performance, and can go so far as to impact employment in adulthood. The availability of that care, however, is also central to containing avoidable healthcare costs. Our own internal data from more than one million Kool Smiles patients shows that low-income children who see a dentist by their third birthday are less likely to need expensive restorative or emergency room visits, and their average dental-related costs are almost 35 percent lower than children who did not see a dentist early. Children able to visit a dentist before their third birthday experienced restorative costs 32 percent lower than for their peers, extraction costs 57 percent lower than their peers, and had 33 percent fewer restorative and extraction procedures overall.
The fact that marketplace plans for children have fallen short – and the impending expiration of CHIP in 2017 – presents us with an unsettling prospect for the future of children’s health care. CHIP has been a central element in improving the lives and the health of children for almost two decades. It works – which is why our lawmakers should act decisively and ensure permanent funding.
Gifford is managing dental director for national children’s dental provider Kool Smiles.