After Sinking Months Into Failed Repeal, Congress Poised To Let Health Programs Expire

After spending most of the month on yet another failed bid to repeal the Affordable Care Act and block-grant Medicaid, Congress is set to leave town without reauthorizing the Children’s Health Insurance Program (CHIP) or payments for hospitals that serve the uninsured – and without passing a bill to stabilize Obamacare’s individual market, leaving it vulnerable to President Trump’s whims.

Sen. Claire McCaskill (D-MO), who sits on one of the key committees in charge of health care, confirmed to TPM that Congress will likely allow CHIP to lapse by Saturday’s deadline, putting the health insurance of millions of children in jeopardy.

“I’m confident the money will come but obviously it’s not going to come on time,” she said wearily.

Funding for CHIP, which provides health insurance for nearly 9 million children nationwide, expires this Saturday. The Senate Finance committee has worked for months on a bill to reauthorize it for the next five years, but the work was pushed to the back burner as Republicans chose instead to spend weeks taking one last unsuccessfully run at repealing Obamacare.

“If I had had my way, we would have spent our week working on getting a Children’s Health insurance plan passed,” grumbled Sen. Ron Wyden (D-OR), the top Democrat on the Finance Committee that oversees CHIP. “Regrettably, we had to spend a lot of our time trying to finally push back on Trumpcare 2.0. Let me tell you what the consequences are. Different states are affected in different ways, but we had testimony in the committee from a mom who said, ‘If the money runs out, I’m going to have trouble figuring out how to pay for prescriptions for my kid.'”

While many states have enough funding in reserve to keep funding CHIP until Congress acts, a handful of states are right on the brink of running out of money, including Arizona, Minnesota, North Carolina, and the District of Columbia. Many more would see their funding dry up in the first few months of 2018.

“There will be cash flow problems for a lot of states that don’t have any cushion in terms of cash flow. I hope they have ways to manage that,” McCaskill told TPM, adding that the Senate is working to pass a reauthorization as soon as possible that would be retroactive.

Lawmakers confirmed Thursday that Congress is also likely to miss the Saturday deadline on Disproportionate Share Hospitals (DSH) payments. If scheduled cuts are not pushed back, the hospitals that serve the low-income and uninsured could face a shortfall of billions of dollars.

The House is set to mark up its own CHIP bill next week—too late for Saturday’s deadline.

As the Senate prepared to leave for the week without action on either CHIP or DSH, Wyden insisted there was still time to act but not the necessarily political will.

“We have the rest of the week,” he said. “I’m willing to pull out all the stops to get this done.”

Sen. Orrin Hatch (R-TX), the chair of the committee, waved away concerns, telling reporters: “We’re going to reauthorize it, hopefully before the end of the month, or shortly thereafter.”

Meanwhile, in the Senate’s other committee in charge of health care, attempts to produce a bill to stabilize Obamacare’s rocky individual insurance market have not yet been successful.

Though Senate Minority Leader Chuck Schumer (D-NY) took to the floor Thursday to announce that Republicans and Democrats were “on the verge of a deal” to guarantee payments to insurance companies that cover care for low-income patients, the top Democrat and Republican negotiating the deal significantly played down their odds of success.

“It’s not a matter of whether Senator [Patty] Murray and I agree,” Sen. Lamar Alexander (R-TN) told reporters Thursday. “It’s a matter whether we can find a consensus among Republicans and Democrats that we believe we can be enacted. She and I might be able to come to an agreement tonight, but that won’t do the job. We need a significant number of Democrats and Republicans, and then we have the job of persuading the entire Senate, the House of Representatives and the president. We’re taking it one step at a time.”

As with CHIP, Republicans abandoned the stabilization talks in favor of another repeal vote. When that effort collapsed this week, Alexander and Murray said they were picking back up where they left off, but would not give reporters a firm timeline for producing a bill.

Asked if he knew whether the Trump administration would continue to make the CSR payments until a bill is passed, Alexander, the chair of the Health, Education, Labor and Pensions Committee, demurred.

“You’ll have to ask them that,” he told TPM.

Wyden, who similarly has not received guidance from the White House, said the uncertainty caused by the administration’s will-he-won’t-he dance around the CSR payments would “be funny if it wasn’t causing so much hurt.”

“This is an administration that makes a big deal about saying they’re for private health care and the business community,” he said. “And what does the private sector care about the most? Certainty and predictability. But for months and months, the president of the United States has been pouring gasoline into the private health care marketplace.”