t was just part of a routine well-baby exam, the kind of screening Jimmy L. Stewart, a pediatrician in Jackson has done thousands of times.
This time, however, when Stewart examined the six-month-old baby’s eyes, he noticed something was wrong. An immediate referral to a pediatric opthamologist revealed a cancerous tumor behind the child’s eye.
It was every parent’s nightmare, without question, but the timing of the discovery was crucial to the child’s chances of recovery.
“Because we caught it early, “Stewart said, “it can be treated, and the outlook is promising. I can’t tell you how many times a simple, routine exam catches something very important,” Even a delay of weeks or months in a case like this could have a catastrophic impact on the child’s future, Stewart said.
Thousands of children
depend on program
Since 1997, thousands of Mississippi children between birth and 19 years old have had access to routine wellness check-ups, prescription medicine, chronic disease management, and hospital care through the federal Children’s Health Insurance Program, (usually shortened to CHIP).
For 79,286 children in Mississippi, however, the future of that care hangs in the balance now that reauthorization of the program, which expired Sept. 30, has stalled in Congress. (That number includes children on CHIP and those on Quasi CHIP, who were moved onto Medicaid through provisions of the Affordable Care Act.)
Although CHIP has garnered bipartisan support over the years, arguments over how it should be funded mean that the U.S. House and Senate have yet to agree on a final form of the reauthorization bill and are unlikely to take it up anytime soon.
Millions of children are at risk of losing their coverage this month. Three states, Arizona, Florida, and Minnesota, as well as the District of Columbia are projected to run out of money by the end of December.
Another five will exhaust funding at the end of January, according to information compiled by the Medicaid and CHIP Payment and Access Commission.
Money in Mississippi is set to run out
in April 2018
In a poor, rural state like Mississippi, there are few options to replace the funding CHIP provides, but officials say they are monitoring the situation. Erin Barham, a spokesperson for the state’s Division of Medicaid, which administers CHIP, said that the state estimates that funding for CHIP will last at least until the end of April 2018. “We remain hopeful that Congress will take action prior to that time,” she said.
The state has begun initial contingency planning in case the money does run out, Barham said.
“If it gets to that point, we will review beneficiary cases, and they will be assessed for alternative, appropriate categories if eligible,” she said. “The agency will take appropriate steps per guidance in the law regarding notification of beneficiaries.”
Both of Mississippi’s Republican United States senators have voiced support for CHIP, and the state’s senior senator, Thad Cochran, has been a long-time proponent of the program. Cochran said through a spokesperson that he remained optimistic that the impasse will be resolved.
“I voted for the legislation that created CHIP in 1997,” Cochran’s statement said, “and I continue to support this program, which is important to many families in Mississippi.”
CHIP makes for a healthy childhood
Fallon Sutton of Jackson is also watching the CHIP reauthorization process closely. The program has covered Sutton’s boys, Jaden 18, Makare, 12, and Jamari 9, all of their lives, and their mother credits a childhood of regular wellness checkups with helping them flourish. “They are all very active, very healthy guys,” she said.
If she were to lose coverage for her sons, Sutton might face stark choices about their care, choices that could have lasting consequences, she said.
“That preventive care is so important. I’m glad I can take them in for a small cough and get it taken care of before it gets so bad we end up in the emergency room,” she said.
Sutton also credits CHIP for helping her sons understand how to take care of themselves in the future. “They’ve been doing it for so long it’s become a norm. Those habits are going to stick with them through their adult lives, and they will do the same to care for their children” she said.
With the reauthorization still unsettled, Sutton is examining her options. A single mother, she works as an administrative assistant at a state university. Although her employer covers most of her insurance, her portion costs $38 every two weeks. If she were to add her three sons to that coverage, her cost would increase by $186 per two-week pay period, a jump that would cut her $29,000 per year salary down to “a very thin line,” she said, “a lot of people, including myself, would be in bad shape.”
She hopes that officials in Washington know how important CHIP is to families like hers.
“They should think of the working class. We are working,” Sutton said, “But there are still things we need and can’t afford, like health insurance and CHIP is one thing that I think they should keep. It’s a must.”
As she waits, Sutton said she does the only thing she can at this point. “I just pray.”
Families eye “terrifying” prospect
Jorja Hurdle of Holly Springs echoed Sutton’s concerns. She and her husband both work but cannot afford health insurance for their two daughters, ages six and two. For most of their lives, Hurdle’s daughters only needed wellness care, she said, but last year, her oldest daughter had recurrent bouts of strep throat and had her tonsils removed. Soon after, the toddler was hospitalized with a bacterial infection.
“We looked at those bills. There is no way we could have paid them without CHIP. We would have had to declare bankruptcy,” Hurdle said.
With the future of CHIP in limbo, Hurdle and her husband have begun seeking other insurance options, but the situation is causing them “lots of stress and worry,” Hurdle said.
“We were doing some calculations last night, and my husband put his hand over his heart — he almost had a panic attack just thinking about it. It’s terrifying,” she said.
Loss of CHIP could force difficult choices
Dr. Jimmy Stewart at the University of Mississippi Medical Center worries about the kind of choices that Mississippi parents like Hurdle and Sutton might have to make if CHIP disappears.
“A lot of people will say they want families to be able to choose to access health care, but kids have choices that are forced upon them. You know, 90 percent of the time, parents are going to make good choices, but if they have limited resources, then they are going to have to think about rationing those resources. That’s just not something we want families to have to deal with,” he said.
Stewart sees few options for replacing CHIP’s care in a state like Mississippi, where much of the population is rural and poor. “Mississippi doesn’t have the resources to fill in the gaps. We wouldn’t have a whole lot of alternatives, especially in rural areas where there are entire counties that don’t even have a pediatrician. It would be tough,” he said.
In 2016, the federal government sent $287.5 million to Mississippi to fund CHIP About 49 percent of the state’s children are covered by Medicaid and CHIP. In more than 20 counties, 60 percent or more of the children are enrolled in CHIP in one form or another. In Issaquena County, 84 percent of the children receive their care through the program, according to the Georgetown University Health Policy Institute.
ELLEN B. MEACHAM is an author and journalist in Oxford. She is a former staff writer for the DeSoto Times-Tribune. Her book, Delta Epiphany: Robert F. Kennedy in Mississippi will be available on amazon.com and at fine book stores.