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Honorable Mark Sanford

Representing the 1st District of South Carolina

Vote Notes: H.R. 3922 - Championing Healthy Kids Act

Nov 28, 2017
Blog Post

Happy post-Thanksgiving!

I do hope that yours was a good one. Thanksgiving really is my favorite holiday...ours is a frenetic one with lots of outdoors, hunting, and more down at the farm. In whatever your tradition might be, I do hope that you were with family, friends, and loved ones….

Under the category of catching up with vote descriptions that came before Thanksgiving, let me reference the vote we took earlier in November on the CHIP program. Technically, it’s called the State Children’s Health Insurance Program, and it expired in September, which brought the vote up in November.

It passed 242 to 174, and I voted for it because it represented a number of forward steps in dealing with entitlement funding. These were small steps...but important. I’m most critical of the way in which many funding decisions are made in Washington, but this bill represented the kinds of action we ought to see more of up here.

It did three things that we’re going to have to do with entitlement spending going forward. One, the bill was paid for...precious little is these days. Two, it included a small degree of means testing that just makes common sense on an entitlement program that is mostly paid for by the taxpayer. Finally, it curbed the federal commitment on what had become an open-ended commitment to states.

To get our arms around entitlement spending, we’re going to have to do a lot more of each of those things to get our budget back in balance. But let me explain in a little bit more detail the program and what made sense on each of these three steps that the bill took on these fronts.

First, what is CHIP? It’s a joint federal-state program that provides health insurance for children in families that do not qualify for Medicaid. While it is an entitlement program, it is different from Social Security and Medicare because its funding is not automatic. This means that Congress must authorize new funding for it to continue. Indeed, this bill extended CHIP funding for five years and was fully paid for.

The particular ways in which bills are paid for are called “offsets.” In this case, four of the offsets made permanent changes in law that will allow savings to gather beyond the ten-year budget window. Another offset that I viewed as important made cuts to the Affordable Care Act’s Prevention and Public Health Fund. That fund has essentially been a $2 billion slush fund for the Department of Health and Human Services to spend on whatever it wants without oversight from Congress. Some $12.5 billion was earmarked for it over ten years and has been spent on things like massage therapy, funding for groups that want higher taxes on tobacco and soda, and zoning laws against fast-food restaurants. Even if one thinks these are worthy of taxpayer support, at the very least they should be cleared by Congress. This bill cut that fund over eight years and then completely zeros it out. There is a simple principle here: the Constitution authorizes only Congress to authorize spending. The closure of this particular portion of CHIP funding was important and even outside of the confines of the three things I thought most vital about the bill.

The means testing came in two ways.

One, it would, for the first time, change eligibility requirements so that states can remove jackpot lottery winners from their Medicaid rolls.

Is this not insane? A study of just Michigan lottery winners alone found that there were 3,500 lottery winners last year alone who were receiving welfare, food stamps, or other aid. In fact, back in 2012, Governor Rick Schneider signed a measure trying to curb at least a part of this when two people were found using food stamps despite winning $700,000 and $850,000 lump sum prizes. Is that crazy or what? You win almost a million dollars, but you’re still able to draw down federal funds? This is what drives people crazy about government. What the study showed in Michigan was duplicated in nearly every other state in this country.

The other part of means testing came to earners over $500,000. This is not a big group, but it would require them to pay a greater share of the premiums for Part B and D. It’s currently 80 percent and would move to 100 percent of their premiums. The Congressional Budget Office (CBO) estimated the change would save $5.8 billion over ten years.

Finally, some states had 100 percent of their CHIP programs funded by the federal government - no matter how generous their programs were. This raised at least two problems: one, how much do you care about something that’s paid for 100 percent by someone else? This was the case between many states and the federal government. It also means that states that tried to be more judicious in the way that they spent CHIP money in essence were subsidizing states that weren’t.

New York is a good example. It had high income eligibility levels (a family of four with $99,000 /year qualified) and a 100 percent federal match rate. That meant that taxpayers were footing the entire bill for New York’s generous CHIP program. The bill improved this situation by limiting eligibility to lower-income levels and reducing the federal match rate back to the historical levels of 70 percent.

Again, these weren’t big steps, but they were important for what they hopefully could point to as it relates to entitlement funding at the federal level. This bill will now come back to the House probably next week in a conference report. If it stays true to these larger precepts, I’ll again vote for it...and if it doesn’t, I won’t.

Happy post-Thanksgiving!