The Children’s Health Insurance Program at Twenty: Essential yet Expired

By Elliott Gluck
Associate Editor, Volume 23

chip-landing-page-infographic.jpgThe Children’s Health Insurance Program (CHIP) has been a triumph of effective bipartisan policy for the last two decades.[1] Unfortunately, the program which has helped to lower the uninsured rate for America’s kids, from 14 percent in 1997 to just 4.5 as recently as 2015, was allowed to expire this Fall.[2] While CHIP is an essential program for a diverse array of families, it has been especially impactful in communities of color. In tandem with Medicaid, CHIP covers nearly 40 percent of kids in the United States, and of those children benefitting from the program, nearly 60 percent are African American or Hispanic.[3] If Congress fails to act, states will soon run out of funding and millions of children could be at risk of losing coverage.[4] This would exacerbate racial disparities in access to healthcare and the negative outcomes that follow from a lack of coverage for kids.

Implemented during the Clinton administration, CHIP provides coverage for children in families whose incomes are above the Medicaid thresholds but would otherwise struggle to afford insurance.[5] “While CHIP income eligibility levels vary by state, about 90 percent of children covered are in families earning 200 percent of poverty or less ($40,840 for a family of three). CHIP covers children up to age 19. States have the option to cover pregnant women, and 19 do so.”[6] From the perspective of pediatricians, CHIP both saves and improves the lives of the children and families it covers. Dorothy Novick, a pediatrician at the Children’s Hospital of Philadelphia, notes,

Every day I see patients in my practice who stand to lose their health care if Congress does not act to extend CHIP funding. Consider my patient who grew up in foster care, put herself through college and now earns a living as a freelanceclothing designer. She is now a mother herself, and I treat her children. Her 1-year-old son has asthma and her 3-year-old daughter has a peanut allergy. They are able to follow up with me every three months and keep a ready supply of lifesaving medications because they qualify for CHIP. Or consider the dad with a hearing impairment whose wife passed away two years ago. He supports his teenage daughters by working as a line cook during the day and a parking attendant at night. He sends the girls to a parochial school. He lost their Medicaid when he was given extra hours at his restaurant last year. But I still see them because they qualify for CHIP.[7]

These real-world examples show the importance of health care coverage in assuring kids reach their potential through healthy development from infancy through adolescence.[8] Studies show that “[c]ompared to healthy children, unhealthy children are at higher risk for school problems, failing, or dropping out. Children who have health insurance through Medicaid or CHIP have better access to health care and do better in school than their uninsured counterparts.”[9]

With 11 states at risk of running out of federal funds by the end of 2017 and another 20 states facing the same cliff within the first few months of next year, millions of families could see the benefits of health insurance coverage through CHIP fall by the wayside, especially in states whose CHIP programs are not connected to Medicaid.[10] This scenario would almost certainly have a dramatic impact on communities of color given the high participation among African American and Hispanic families in the program. Children of color already face disproportionate levels of adversity due to inequities in education, criminal justice, and economic opportunity, just to name a few. If affordable healthcare is put out of reach for these kids and families, these disparities will only be exacerbated. For those reasons, it is essential that Congress renew the bipartisan approach to healthcare for kids by reauthorizing the Children’s Health Insurance Program before the end of the year.

[1] Valerie Strauss, 9 Million Kids Get Health Insurance Under CHIP. Congress Just Let It Expire., Wash. Post (Oct. 1, 2017),

[2] Id.

[3] Dee Mahan, The Children’s Health Insurance Program (CHIP), Families USA (2017),

[4] Rachana Pradhan & Sarah Frostenson, States may roll back children’s health coverage without money from Congress, Politico (Oct. 23, 2017),

[5] Strauss, supra note 1.

[6] Phil Galewitz, Lapse in Federal Funding Imperils Children’s Health Coverage, NPR (Oct. 3, 2017),

[7] Strauss, supra note 1.

[8] Mahan, supra note 3.

[9] Id.

[10] Editorial, Congress, End the Health Care Chaos. You Have 9 Million Kids to Protect., N.Y. Times (Oct. 18, 2017),