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Children’s Health Insurance Program (CHIP) in danger; offering some solutions

Feb. 19, 2015
This important program for children's dental health has the support of many organizations to keep it going. DentaQuest CFO Steve Pollock explains what is being done.

February is National Children’s Dental Health Month, designed to promote the dental health of children across the nation. But one of the biggest success stories in public policy – increasing access to and reducing the cost of quality dental care – could be in jeopardy.

Since its creation in 1997, the Children’s Health Insurance Program (CHIP) has been a critical source of health coverage for children and pregnant women who earn too much to qualify for Medicaid but too little to purchase private health insurance.

RELATED ARTICLE:Youth across the country taking part in February activities to promote better oral health

The Affordable Care Act (ACA) assures funding for CHIP only through fiscal year 2015, so now it’s up to Congress to allocate funding for the program to continue. One of the organizations leading the effort to extend CHIP funding is DentaQuest, the third-largest dental benefits provider in the country.

DentistryIQ was able to ask Steve Pollock, COO of DentaQuest, a few questions about the importance of renewing CHIP. Here’s what he had to say.

QUESTION: When did you and your colleagues become aware of the discontinuation of funding for CHIP?
Since the passage of the ACA, we’ve known that the law authorizes the Children’s Health Insurance Program (CHIP) through 2019 but only provides funding through this September. It was not until more recently, however, that we became concerned Congress may not act to continue funding the bipartisan program. Now we’ve taken a more active role in advocating for an extension of CHIP funding given its critical role in providing comprehensive oral health coverage to more than 8 million children.

DentaQuest is one voice in the choir of those advocating for the continuation of CHIP. In addition to a wide range of industry, consumer, provider, and children’s advocacy groups, 39 governors, both Democrat and Republican, sent letters to Congress late last year highlighting the success of the CHIP program in their states and urging federal lawmakers to extend CHIP funding now.

Q: Why is this happening after 18 years of success?
The ACA significantly changed the health care landscape. It created health insurance marketplaces where individuals, families, and small businesses can purchase affordable coverage that covers a set of essential health benefits. The marketplaces provide subsidies to individuals and families with incomes up to 400% of the federal poverty level to help purchase coverage. However, these reforms where designed knowing that CHIP would continue to cover low- and moderate-income children. As a result, the ACA changes are targeted to adult populations, not children.

While some have expressed concern that CHIP may be redundant in a post-ACA world, this is simply not true. In fact, when it comes to comprehensive dental coverage, CHIP is even more necessary to guarantee coverage for children. The marketplaces do not guarantee pediatric dental coverage, and nearly 2 million families who may choose to purchase dental coverage will not be eligible for subsidies due to a flaw in the ACA’s affordability test, the so-called “family glitch.”

Dental disease is the most prevalent chronic illness among children – five times more common than asthma. Yet it is mostly preventable. CHIP has made significant progress in ensuring children’s access to critical oral health care, but if Congress does not act now that progress may be reversed.

Q: Do you have any statistics about its success, and how those stats will change with CHIP’s discontinuation?
Today CHIP serves more than 8 million low- and moderate-income children and nearly 400,000 pregnant women who do not qualify for Medicaid. Between 1997 and 2011, CHIP was successful in reducing the rate of uninsurance and unmet health needs of children. This is especially significant because these gains were made at a time when uninsurance among adults increased.

Research has also shown that racial and ethnic disparities in access to care among CHIP-eligible children were dramatically reduced or all together eliminated after enrollment.[i] In a recent survey of state CHIP directors, the National Academy of State Health Policy found that most states are operating under the assumption that funding will be extended. However, if Congress does not act by spring, state officials will take steps to close their CHIP programs. These steps include discontinuing new enrollment and notifying current enrollees in separate CHIP programs that the program will end.[ii]

Q: What is DentaQuest doing to “lead the charge” to pressure lawmakers?
With so many new members of Congress, a lot of our advocacy efforts have been focused on education. Many recognize the importance of CHIP in providing health coverage to children, but most do not realize the significant impact the program has on children’s oral health. We want to make sure lawmakers understand the unique role that CHIP plays in closing the oral health care gap, and the significant health and economic consequences that will be felt in every state if the CHIP program were to be eliminated.

Q: Why is DentaQuest leading this charge, and how has it been going?
SP: More than 1,200 different organizations have signed onto a letter urging Congress to act now to extend funding. I think that’s a clear illustration of the type of support this program has from all types of stakeholders. More can and must be done to educate members of Congress about the critical role CHIP plays in closing the coverage gap for children. This is especially true for members who were not part of the creation or CHIP in 1997 or the reauthorization in 2009. In both those instances, CHIP enjoyed bipartisan support.

Q: Who are some of those who have become involved along with DentaQuest?
SP: Ensuring that CHIP continues to be a successful program is absolutely a group effort. No one organization can make it happen in a vacuum. We’ve followed in the path of a number of national leaders and partnered with organizations such as First Focus, Children’s Dental Health Project, National Association of Dental Plans, and others to add our voice to the call to action.

Q: What are some of the next steps in this effort?
There is a small window to ensure CHIP funding is included in a moving legislative vehicle before state budget officers and CHIP directors will have to start making significant cuts to their CHIP programs or possibly shutting them down completely. For that reason, Congress must act now. While CHIP is currently funded until September of this year, we cannot afford to leave states and the children they serve in limbo beyond the spring.

Q: What can folks do to help and let their voices be heard?
It is critically important that members of Congress hear from their constituents. That could mean activating your grassroots network or simply picking up the phone to tell your member of Congress how important CHIP is for your community. Talking with state leaders and asking them to weigh in with your state’s congressional delegation is also important. Because CHIP is viewed as a popular and successful program, it is easy to assume that Congress will extend funding. However, we cannot rest on that assumption. We must act if we expect Congress to act.

Q: What makes CHIP so successful?
The CHIP program serves working families. It makes coverage accessible while ensuring that families are not overwhelmed by unsustainable health care costs. CHIP, in concert with Medicaid, serves over half of Hispanic and African-American children nationwide. These children face some of the most significant health disparities, and ensuring coverage through the CHIP program is a significant step in promoting health equity.

Q: How else has DentaQuest been involved in helping the underserved population?
Our mission is to improve the oral health of all. With the assistance of our charitable Foundation and our quality improvement Institute, DentaQuest is using innovation, education, and strategic outreach to connect people with preventive care before problems become invasive and costly. We are committed to eliminating oral health inequities based on socially determined circumstances, including race, ethnicity, age, and more, and we work with local, state, and national partners to educate and mobilize communities to consider oral health in health care and policy decisions.

Q: What would you like to add that we did not ask here?
Coverage is critically important but we must also ensure that children have access to the right care at the right time. Prevention-based care, the core of our approach, when delivered during developing stages of the mouth and teeth, improves oral health and minimizes the need for more expensive care later in life. DentaQuest is using innovation and strategic approaches to stay in front of ever-changing best practices in the dental field.

Steve Pollock has been with DentaQuest since 1999. He was named Chief Operating Officer in 2011, with oversight responsibility for all business segments. Before this, he served in several roles, including president, executive VP, VP of market development, and general counsel. Steve has led DentaQuest's growth in the evolving health care marketplace through his commitment to good people practices, innovative technology, and efficient processes.

Children’s Health Insurance Program (CHIP): Accomplishments, Challenges, and Policy Recommendations. The American Academy of Pediatrics, 2014.