Improbable as it may sound, House Republicans are on the verge of approving, without much fanfare, a major priority of Hillary Clinton's.
When Clinton ran for president in 2008, she touted her role as first lady in "designing and championing" the Children's Health Insurance Program, or CHIP, which provided coverage for millions of children whose parents did not qualify for Medicaid but could not afford private insurance. At the time President Clinton signed the law in 1997, it constituted the largest expansion of government-funded children's health insurance since the enactment of Medicaid in 1965.
On Tuesday, Republicans unveiled legislation that would extend CHIP for another two years, without spending cuts or changes of any kind. The program's funding is due to expire at the end of September, making this an unusual case of Congress moving to act well in advance of a deadline. You won't hear much about the CHIP extension from Republicans, however. They are supporting it to gain Democratic backing for one of Speaker John Boehner's top goals: a package that permanently prevents steep cuts in Medicare payments to doctors and institutes a few long-sought reforms to the entitlement program. The so-called "doc fix" is an annual headache for both parties, and repealing it for good has commanded most of the attention inside the Beltway. Yet extending funding for children's health insurance is equally significant, and its inclusion in the bill represents a rare bipartisan breakthrough, as well as a sign that the nation's improved fiscal footing is helping to ease the gridlock in Congress.
That Republicans might extend CHIP is a testament to its popularity. After 18 years on the books, the program is an accepted component of the social safety net. Health policy experts say it has succeeded in its original goal of providing coverage to more than half of the nation's uninsured children. And when congressional leaders asked governors last year what to do with the program, both Republican and Democratic state leaders urged them to continue it, said Ron Pollack, the executive director of FamiliesUSA. CHIP's trajectory is a mark of hope for supporters of Obamacare—and a reason for fear among conservatives. The longer a government program endures, the more popular it becomes, and the harder it is to eliminate it.
Still, there's a crucial difference between CHIP and the Affordable Care Act, aside from the much broader scope of the 2010 overhaul. "The Children's Health Insurance Program has, from its origination, been a bipartisan program," Pollack noted. In Congress, it was the brainchild of the late Senator Ted Kennedy and Senator Orrin Hatch, a Republican of Utah who now heads the Finance Committee. Hillary Clinton, just three years removed from her failed bid to shepherd universal health care into law, championed the more limited insurance expansion from the White House. It was ultimately included in a larger budget deal that Republicans passed and President Clinton signed in 1997. A decade later, Hillary Clinton drew some criticism for embellishing her role in the program's passage, given that she stayed mostly behind the scenes after stumbling on health care earlier in her husband's tenure. "Success has more than one set of parents in the political arena," Pollack said. "Clearly, she played a significant role."
Count on Clinton to tout CHIP again during her 2016 presidential run, especially considering the bipartisan effort it took to create it. Along with Bill Frist, the Republican former Senate majority leader, Clinton co-authored an op-ed last month in The New York Times urging Congress to extend the program. "This is an opportunity to send a message that Washington is still capable of making common-sense progress for American families," they wrote.
As 2015 unfolds, we know Congress will continue to debate the future of health care reform. We most likely won’t see eye to eye about some of the more contentious questions. But one thing everyone should be able to agree on is that our most vulnerable children shouldn’t be caught in the crossfire.
While CHIP began as a bipartisan program, it did not escape the ideological battles of the last decade over healthcare. President George W. Bush signed the first reauthorization in 2007, but only for two years and only after vetoing two Democratic attempts to expand it. President Obama signed the expansion shortly after taking office, despite opposition from most Republicans. The Affordable Care Act extended the program again through this coming September.
Given CHIP's popularity, conservative fiscal hawks didn't realistically expect the GOP Congress to let funding completely run out in September, but they hoped Republicans would demand reforms to the program, starting with a roll-back of its expansion under Obama. "I don't think there's any doubt that Republicans and Democrats have sort of accepted that CHIP is here," said Dan Holler, a spokesman for Heritage Action, a conservative group frequently at odds with Boehner. Heritage's main objection to the $200 billion Medicare deal is that it will add significantly to the deficit, but Holler also said Republicans "missed a huge opportunity" to reform CHIP.
An even bigger fear, Holler said, is that Boehner's deal with Minority Leader Nancy Pelosi will set a precedent for future big-spending agreements with Democrats. After facing revolt after revolt from conservatives, the speaker changed course when it came to fixing the Medicare reimbursement rate. As National Journal's Daniel Newhauser reported, Boehner went first to Pelosi to strike a deal, not to his right flank. Congress faces another set of deadlines on the debt ceiling and the Highway Trust Fund in the coming months, and with the improving economy helping to bring down the deficit, more bipartisan deals could come as lawmakers loosen the federal pursestrings. Instead of fighting over how which programs to cut, Democrats and Republicans may strike more bargains in which they agree to fund each other's priorities.
Boehner hasn't publicly discussed the children's health program extension, but a House Republican leadership aide noted that the deal was only for two years, not the four that Democrats wanted. That could give Republicans time to enact reforms that would be implemented by the next president. "By extending CHIP, this bill would keep more than three million people from being uninsured or enrolling in the Obamacare exchanges over the next decade," the aide said. While the bill is seen as likely to pass the House this week, Democrats in the Senate could put up a fight over the length of the extension or abortion provisions tucked into the legislation.
For advocates like Pollack, the quicker the measure passes, the better—in part because of concerns that a Clinton campaign could complicate things. If Hillary is out on the stump demanding that Congress reauthorize CHIP, support among Republicans could disappear, especially with increased pressure from conservatives. "It's fair to say," Holler noted, "that Hillary Clinton's healthcare legacy is being extended in this deal."