The goal of health care reform is supposed to be fixing what’s broken: covering Americans who are uninsured, making health care affordable and accessible and improving quality of patient care.

However, the House-passed health care bill would take away existing coverage from an estimated 14 million U.S. children, according to the Children’s Defense Fund. The legislation that narrowly passed the House would cancel most states’ Children’s Health Insurance Programs in 2013 with the expectations that the children along with their parents would be covered by insurance sold in new exchanges that the bill proposes to start that year. Only CHIP programs that are an expansion of Medicaid would be retained.

39 state kids plans

Thirty-nine states that have stand-alone CHIP programs would have those programs repealed by the House bill, according to First Focus Campaign, a children’s advocacy organization. Montana is one of the 39.

The bill amended and approved by the Senate Finance Committee wouldn’t curtail CHIP, but calls for the program to be reevaluated when it’s next due for reauthorization in 2013. Sen. Max Baucus, who chairs the Finance Committee, supports that provision in the bill, his spokesman, Ty Matsdorf, said last week.

It was only several months ago that Congress (with the support of Montana’s entire congressional delegation) and President Barack Obama reauthorized CHIP, something former President George W. Bush had refused to do.

In Montana, the state health department is just several weeks into running an expanded children’s health coverage program as directed by an initiative voters approved in November 2008. Healthy Montana Kids combines Medicaid and CHIP, offering families a single application for government-funded coverage for children who are otherwise uninsured and meet low to moderate income guidelines.

 Anna Whiting Sorrell, director of the Montana Department of Health and Human Services, declined to speculate on how the CHIP provision in the House bill would affect Montana if it became law.

“At this point, we are just waiting to see what the overall bill will contain,” she said from Helena. “The most important thing we can do is run the best Healthy Montana Kids program we can. When people see the success of that, it will help.”

DPHHS is processing “a flood of applications” for the program since eligibility guidelines expanded on Oct. 1. Sorrell expected that data on applications and numbers of children enrolled will be available this week.

Montana program

Montana CHIP operates much like private insurance. The state contracted with Montana Blue Cross Blue Shield to administer the program, which covered 19,000 kids ages birth through 18 in late September. Care is available free or at very low cost to children with the federal government paying about 80 percent of costs and the state paying most of the balance.

Congressional Budget Office director Douglas Elmendorf has said that the proposed exchange plans would have higher premiums and higher out-of-pocket costs than CHIP.  That kind of change would leave families with CHIP children worse off than they are now.

Marian Wright Edelman, leader of the Children’s Defense Fund, recently urged grownups to tell their congressional delegations “not to hand over millions of children who were in CHIP to an untested and far costlier exchange driven largely by insurance companies who will profit at the expense of our children’s well-being.”

Shifting millions of children who already have coverage into these proposed new exchanges is a terrible idea. If such exchanges are established, once they are operating smoothly and providing affordable family coverage, then there should be a plan to phase children into them.

But for starters, let’s keep kids in CHIP where they are already covered.