Last Saturday, Congress failed to reauthorize the Children's Health Insurance Program (CHIP), jeopardizing systems that provide low-cost insurance for almost 9 million kids and hundreds of thousands of pregnant women in families that make too much money to qualify for Medicaid but still need assistance. Legislators failed to renew other safety net programs as well. But missing the window on CHIP was a particularly egregious fumble, and one of the clearest signals to date of how desperate this Republican-led Congress is.
"A deadline is often a reliable tool for kicking Congress into high gear," said Brookings Institute Congress watcher Molly Reynolds, "especially on a popular program like CHIP."
Only this time, that wasn't enough.
Since its birth in 1997, the bipartisan brainchild of Republican Orrin Hatch and Democrat Ted Kennedy has lowered children's uninsured rates from 14 to 4.5 percent and demonstrably improved the wellbeing of children and families benefitting from it. A recent Kaiser Family Foundation poll found that 75 percent of respondents thought it was very or extremely important to get it reauthorized, making it voters' leading healthcare priority. Even when Congress has gotten into spats about the program in the past, politicians have at least managed to pass short-term extensions. To wit, in 2015, conservatives moved to strip an increase in the share of CHIP the federal government would pay mandated by the Affordable Care Act (ACA). Congress never resolved that tiff, but it still managed to kick the can down the road with a two-year extension of CHIP as it stood, with five months to spare before its expiration date.
Getting at least a similar deal done this year should have been easy, especially after the deal between President Donald Trump and the Democrats in early September on the budget and the debt ceiling significantly cleared Congress's schedule. "At the start of September," said Reynolds, "a CHIP reauthorization was likely to be one of the top items on their agenda."
And by most accounts it was. Hatch and Democratic Senator Ron Wyden had been working for months on a bipartisan compromise bill to reauthorize CHIP for five years, while slowly phasing out the federal funding boost that stirred up so much trouble in 2015, which seemed like it had a good chance of passing. They introduced it on September 12.
Then Republicans decided to throw that reasonable piece of legislation under the bus in favor of the unpopular Graham-Cassidy bill, another crack at repealing and replacing the ACA, and a blatantly desperate bid that failed just as badly as their previous efforts had.
"There was growing attention and movement towards getting [CHIP reauthorization] done," Bruce Lesley of First Focus, a children's advocacy group, told the New Republic last week. "Then Graham-Cassidy came up and everyone stopped talking to us about it. It was hard to get meetings after that, to talk to people."
In theory, the House could have moved on CHIP while the Senate duked it out over the ACA. But, Joshua Huder of Georgetown University's Government Affairs Institute said, "they were essentially in a holding pattern, waiting for the Senate to act on Graham-Cassidy."
Congress could have double-timed it on CHIP reauthorization after the Graham-Cassidy push fell apart last week. Hatch and Wyden both speculated that it still could have passed in time. After all, within the space of one day last week both chambers managed to pass a bill that included the short-term reauthorization the Federal Aviation Administration and three other healthcare assistance programs, at the 11th hour and despite unresolved debates swirling around them, by attaching them to hurricane relief and stripping out contentious elements.
But again, none of this happened when it came to CHIP. This may have been, as Wyden mused last week, because there wasn't enough political will behind the reauthorization push. But it was also because Congress managed to convince itself that the deadline to save the program wasn't the actual deadline. Every state's CHIP program still had some funds left, some reasoned, so missing the deadline wouldn't actually hurt anything as the program could continue functioning as-is for a few days or weeks beyond September 30.
This wasn't an wholly insane assumption; CHIP's funding lapsed in 2007 when George W. Bush vetoed its reauthorization twice, and it did not fall apart. But while no one is losing healthcare instantly as a result of this failed deadline, studies suggest three to ten states will run out of funds for their programs by the end of 2017. Minnesota could run out of funding tomorrow , forcing it to spin up extraordinary measures to keep running, and both that state and Utah are planning to send out notices that the program will be winding down if it's not reauthorized by November 1. Even approaching the red comes with real administrative costs, and all states' budgets are thrown into disarray by this doubt.
"Every day [of] delay increases the risk of funding problems," said George Washington University health policy researcher Leighton Ku. "Some might hit the wall soon."
Now that Congress has scratched its ACA itch, said Huder, it should be able to move quickly on CHIP. The House released a five-year reauthorization bill on Monday and both chambers passed their bills through relevant committees with no incident on Wednesday.
But some outlets are no longerreporting the bills as sure-thing votes. The House is insisting on coupling reauthorization with a sliver of aid for Puerto Rico's Medicaid system and provisions offsetting CHIP's costs with highly contentious tweaks to Medicaid and Medicare. This stands in contrast to the Senate's insistence on a clean reauthorization bill. And the bills only sailed through the committee stage because everyone promised not to propose amendments, but that détente is over and now folks have all sorts of ideas for tweaking the CHIP bills.
"I believe they'll get something across the line before it gets bad," said Huder.
But Congress is now playing with a much fuzzier deadline for CHIP. And as Ku points out, the solutions to current partisan politicking are extremely foggy. It doesn't help that the Senate is about to take a weeklong recess starting on October 9.
"Some in Congress are taking the issue seriously," said Ku. "But overall, the federal government, including Congress, is having difficulties right now because of partisan strife."
In broad strokes, Huder points out, the situation Congress has dug itself into around CHIP is not exceptional. Although we talk about deadlines as motivating action, it's actually imminent and clear crises that do the trick, he says. That's been true for ages, and especially so over the last decade. To Huder, this Congress is not that different from many of its recent predecessors.
But failing to reauthorize CHIP on time arguably crosses a new line of dysfunction. At the very least, this case study tells us that Republican leaders are now so desperate to make good on their Party's promises, like repealing the ACA, that they're willing to justify failing to support vital programs voters really care about in a timely manner. They're also willing to risk terrible optics: Failing on CHIP makes them look incompetent and cruel, all the more so because they openly did so for the incompetent and cruel Graham-Cassidy bill.
This is, in short, another landmark in tone-deaf, scrambling disarray for what was supposed to be one of the most prolific congresses in modern history. It's also a warning that the deadlines fast approaching in December to keep the government running may not prompt action. In other words, maybe the worst is still to come.
Follow Mark Hay on Twitter.