Column: Just three months after Congress gave children’s healthcare a 10-year lifeline, Trump reneges

A mother comforts a sick child in a Chicago hospital room. Will a government healthcare program be there to help?
A mother comforts a sick child in a Chicago hospital room. Will a government healthcare program be there to help?
(Tim Hale / Getty Images)

Those of us with long memories — defined in this turbocharged world as memories that date back more than 90 days — will recall that one of the biggest cliffhangers of that bygone season involved the funding of the Children’s Health Insurance Program, or CHIP.

CHIP, which costs the federal government a paltry $14.5 billion a year but covers 9 million children and pregnant mothers, finally got funded by Congress in January, more than three months after the lawmakers allowed it to expire.

Now President Trump, eagle-eyed as ever for places to save federal funds (except when the money is spent on the 1%), is proposing to strip some $7 billion from funding for CHIP and other children’s programs. That’s nearly half the $15 billion he wants Congress to “rescind” from funds already appropriated for non-defense programs.


Children and states had to wait months for CHIP to be funded. ... This proposal removes reassurances states need.

— Joan Alker, Georgetown University

The CHIP funds aren’t central to the program’s spending — some are contingency funds and some are excess appropriations. But they’re crucial nonetheless, according to child health expert Joan Alker of Georgetown University’s Center for Children and Families.

“Congress has really tried to send a message that CHIP is well-funded and well-supported,” Alker observed Tuesday. Trump’s actions undermine that message. (States contribute to CHIP, but only about 8% on a nationwide basis.)

She’s right about that. As we reported throughout the fall and into the winter, Congress let CHIP expire Sept. 30 because Republicans were fixated on their attempts to repeal the Affordable Care Act and didn’t have the mind space to do two things at once.

What made this process especially grotesque was that the inaction jeopardized the nation’s one indisputable healthcare success: CHIP had reduced the uninsured rate among kids to 5% from 14% over the two decades of its existence.

Moreover, CHIP is one of the few federal spending programs that has enjoyed unalloyed bipartisan support since its inception in 1997 — among its original sponsors was Sen. Orrin Hatch (R-Utah), who kept proclaiming himself the godfather of children’s healthcare funding but couldn’t lift a finger to remove the logjam over CHIP.


States used residual CHIP funds to keep their programs operating, but over the ensuing months, state after state started to run out of money and warned enrolled families that they would have to find children’s coverage elsewhere.

The crisis underscored the absurdity of funding such a crucial health program a few years at a time; last year’s expiration came at the end of a two-year funding block. When Congress finally got around to restoring CHIP funding as part of a continuing resolution passed Jan. 22, it extended the program for six years. Two weeks later, in a second continuing resolution, it extended the program an additional four years, 10 in total.

Yet here comes Trump. “Children and states had to wait months for CHIP to be funded, and finally breathed a sigh of relief when Congress moved forward with a long-term CHIP funding extension,” Alker says. “This proposal removes reassurances states need that funding will be available to keep kids covered.”

The rescission proposal Trump submitted to Congress Tuesday calls for taking $2 billion from CHIP’s Child Enrollment Contingency Fund, which covers unexpected surges in enrollment in individual states. “It’s best thought of as a rainy-day fund,” Alker told me.

Because CHIP is a block-granted program, with allocations to states based on prior enrollments, the fund is there to cover hurricanes, recessions, plant closures — all the imponderables that might land during the course of a year. Trump’s rescission would reduce the contingency fund to about $500 million. “Nobody knows if that will be enough for the rest of the year,” Alker says. “But that’s the point of a rainy-day fund — it’s for the unexpected.”

The other $5 billion in Trump’s gun sights is money initially appropriated for CHIP but not disbursed once the states’ allocations are calculated at the beginning of the year. Traditionally, the excess has been redirected to other children’s programs, such as Head Start. Under Trump’s request, it won’t be available for those purposes.

The administration asserts that the proposed rescissions won’t do any damage to CHIP because the money probably wouldn’t be spent anyway, but it claims the cuts are needed to reduce the deficit even so. In the words of David Super of Georgetown Law School, this argument is “both strange and contradictory.”

Leave aside that Republicans just passed a tax cut that will create $1.5 trillion in deficits over 10 years. If the money wouldn’t be spent, then “there are no savings,” Super observes. As for the contingency funds, “the White House argues that, because the economy seems strong, these funds likely will not be needed. If that is true, the rescission saves no money and is pure theater. If, however, an economic downturn comes, why would we not want to help the newly impoverished as much as the chronic poor?”

He has put his finger on the theatrical element of the rescission request. Trump is feeding meat to a right-wing caucus in Congress that was outraged at a spending bill it considered too lavish. There’s some question whether the request can be filibustered in the Senate, which would mean it’s dead on arrival, and some question whether it could pass in the Senate even on a majority vote.

The real issue comes down to whether Trump and his fellow Republicans can be trusted to keep their word. The continuing resolutions of January and February encompassed commitments to funding CHIP and other programs for children in low-income households. Now, Trump wants to blow up those commitments, as surely as he’s blowing up the Iran nuclear deal, and with scarcely any greater rationale.

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