LIFE MED-PATIENT-ASSESSMENT KHN (copy) (copy)

As patient-centered medical care has taken hold in recent years, there’s been a growing interest in finding ways to use outcomes reported by individuals to help guide care.

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Despite the continuing money problems at the Oregon Health Authority, Oregon Gov. Kate Brown made the right call last week when she said that the state would pick up the tab for the Children's Health Insurance Program even if federal funds run out early next year.

The program (better known, perhaps, by its CHIP acronym) provides coverage for about 120,000 children and 1,700 pregnant women in Oregon; nationally, it serves about 9 million children and 370,000 pregnant women, according to a recent story in The Washington Post.

The people served by the program tend to be from families that earn too much to qualify for Medicaid — in many cases, these are families with working parents that still can't afford health insurance.

Picking up the tab for the program is a relatively low-risk bet for Brown and for Oregon; considering that the program enjoys widespread popularity on both sides of the aisle in Congress, it likely will be renewed. (In fact, one of the program's original authors in 1997 was Republican Sen. Orrin Hatch of Utah.)

But there is some financial risk to Oregon because — well, because this is Congress. A bill to extend the program has been approved by the House of Representatives but has not yet passed the Senate. Although most observers expect Congress to renew the program, no one knows for certain, and as one Virginia state official told The Post, "you can't run a health care program that way. You can't say 'probably' everything is going to be all right." 

Most states have enough money to keep the program running for a few months, but Oregon is among five states and the District of Columbia that likely will be among the first to run out of funding. Observers expect that once Congress finally passes an extension to the insurance program, federal payments will be retroactive to Oct. 1 — which means that states like Oregon that have had to put in their own money to keep the program running would be made whole. But again, because this is Congress, the final result is uncertain, so there is some financial risk to Oregon.

This entire episode offers another good example of how Congress is struggling these days to move ahead on anything. It wasn't all that long ago that renewing a relatively popular and effective program — medical insurance for children, for goodness' sake — would have won congressional approval without anyone even breaking a sweat. 

To that end, a Post story quoted an official at the Georgetown University Center on Children and Families: The program, she said, "is successful. Everyone should feel good about it. There's no reason for this to be lagging on like that. This should be an easy win for Congress."

An easy win? There's no such thing in Congress these days.

As for the effectiveness of the program, this is another one of those cases in which a little money spent upfront saves much more money downriver. Before the program established a safety net for children and families, families without coverage sometimes would wait to get medical care for their children until symptoms became so serious that a trip to the emergency room was the only option. And those emergency room visits are the most expensive stop in the health care system. 

In Oregon, state officials believe that some 40,000 of the covered children would have to move to Medicaid, known here as the Oregon Health Plan. But the state would have to pay to keep coverage for the remaining 79,000 children. Brown said she wanted the state to take action now, so that affected families would have some certainty that their coverage would continue.

It's the right move for Oregon and for these vulnerable families, but it's just a stopgap. Congress should go for the easy win and renew the program. (mm)

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