Providers Debate Whether Bush Administration Rule Allowing CHIP To Cover Fetuses Will Improve Prenatal Care

Witnesses testifying before the Senate Health, Education, Labor and Pensions Committee on Oct. 24 said the Bush administration regulation extending CHIP coverage to fetuses would "presumably exclude not only care for delivery, but potentially critical care needed during pregnancy," CongressDaily reports (Rovner, CongressDaily, 10/24). The rule extends CHIP coverage to fetuses by altering the definition of children to allow coverage "from the moment of conception." Under the rule, pregnant women, including undocumented immigrants, may obtain prenatal care for their fetuses. A bill (S 724) sponsored by Sen. Jeff Bingaman (D-N.M.), who chaired Thursday's hearing, is considered by some to be more comprehensive than the regulation because it would allow pregnant women to receive coverage for a full range of medical services, whereas the regulation would provide care only for conditions that immediately affect the health of the fetus. The bill also would provide health coverage for the child for one year after birth, while the regulation might terminate coverage three months after birth (Kaiser Daily Health Policy Report, 10/16). "As written, the regulation fall critically short," Richard Bucciarelli, speaking on behalf of the American Academy of Pediatrics, said, adding, "[I]t is critically important that pregnant women receive the full range of medical services needed during pregnancy and the post-partum period." Massachusetts General Hospital's Laura Riley, representing the American College of Obstetricians and Gynecologists, said that some physicians might be reluctant to accept pregnant women whose fetuses are covered under CHIP because of uncertainty about which services the Bush regulation would cover (CongressDaily, 10/24). HHS Secretary Tommy Thompson has said that he believes the regulation is more comprehensive than the Senate bill in terms of the coverage that it provides (Kaiser Daily Health Policy Report, 10/16).

Funding
In other CHIP news, health policy experts continue to speculate on whether Congress will take up the issue of increasing federal funding for that program and for states' Medicaid programs, CongressDaily reports (Fulton, CongressDaily, 10/24). All but nine states have reduced eligibility or benefits under Medicaid to rein in costs this year (Kaiser Daily Health Policy Report, 10/11). In addition, some officials have expressed concern that states, responsible for 30% of CHIP's costs and determining eligibility rules, are not receiving enough federal CHIP funding. States have three years to use federal CHIP funds appropriated for a given year, and if they do not spend the money within that time, the federal government redistributes a portion of the unused money to states that exhausted their initial funding. Any remaining unused money must be given back to the Treasury. Earlier this month, twenty-five states forfeited $1.2 billion in unspent CHIP funds to the U.S. Treasury. The money, unclaimed after four years, can be used for purposes other than health programs unless Congress passes legislation to return the funds to state CHIP programs. Further complicating the situation, federal CHIP funding will drop by 26% over the next three years because of a provision in the Balanced Budget Act of 1997 (Kaiser Daily Health Policy Report, 10/24). Speaking at the at the Women's National Democratic Club this week, Chris Jennings, former health policy adviser to former President Clinton, said, "The issue is definitely out there, but it's complicated by ideological differences." He added that Republicans favor state block grants and Democrats support a boost in the federal share of public health programs. Children's Defense Fund officials said that if Congress does not act, some 900,000 children could lose coverage. Greg Haifley, CDF's deputy director of health, said, "One thing that virtually everybody recognizes is that we need to keep the money from reverting to the federal treasury. ... The program is about insuring children, not states getting an allocation and sitting on it." Jennings predicted that the "high stakes" involved in the issue "will be the engine motivating the lame-duck Congress to find some way to fix the problem in December" (Fulton, CongressDaily, 10/24).