With a 6-year-old and a 2-week-old infant, Jolene Ramos of Kila has plenty of worries. But the cost of medical care isn’t one of them. Both of her children are fully covered under Montana’s Children’s Health Insurance Plan, or CHIP.
Ramos, who used to work in sales but is now unemployed, enrolled her daughter in the program two years ago because she and her husband made too much money to qualify her child for Medicaid.
Hers are just two of the 2,256 children in Flathead County enrolled in CHIP, the most of any county in the state, according to the Flathead City-County Health Department.
Last year, voters overwhelmingly approved expanding CHIP. But Montana lawmakers tasked with funding the request fiercely debated whether the state should spend its dwindling budget on growing the program. In the end, the Legislature reached a last-minute compromise for full expansion. What’s not debated is the program’s popularity in the Flathead, where 125 more kids are enrolled than in Yellowstone County, which has 54,000 more people.
Lauri Frisbee, a social worker with Community Health, credits the health department and the Montana Department of Public Health and Human Services for Flathead’s high enrollment. Both departments hand out applications and provide information to families with children who might qualify.
Since March 2008, CHIP enrollment has increased 11 percent statewide, according to the Health Department. In that time, enrollment in Flathead County has ballooned nearly 18 percent.
Frisbee said her office gives out dozens of applications a day. But she stressed that there are still too many kids walking around uninsured, whose parents don’t realize they qualify. Not all families know that teenagers can apply for the program on their own.
“I wish more teens would apply. There are a lot of teens who haven’t been in for 10 years to see a dentist or doctor,” Frisbee said. “We could probably have 20,000 kids just like that on it.”
She doesn’t think CHIP has the stigma that is often attached to low-income insurance programs like Medicaid, and the application process is quick and easy. For example, a Medicaid application is about nine pages, while CHIP is only four.
In 2008, the non-profit health care advocacy group Families USA reported that, according to the most recent Census data, Montana had the eighth-highest percentage of uninsured children in the nation.
That report debuted just in time for the November election, which carried one of the most debated issues on the ballot – I-155. Montana voters approved the measure, also known as the Healthy Montana Kids Plan, by 70 percent.
Eligibility originally required families not to exceed 175 percent of the federal poverty level, cutting a family of four off at $37,000 in annual income. The voter-approved program expanded that percentage to 250 percent, so now a family of four whose income is under $50,000 can qualify.
But once the 2009 Legislature was underway Democrats and Republicans disagreed over whether the state had enough money in its coffers to fund it. While Democrats pushed for the full expansion of CHIP, Senate Republicans wanted to reduce the eligibility threshold approved by voters at 250 percent to 200 percent.
“To be clear, the initiative was funded by diverting a portion of the insurance premium tax that was previously going to the general fund,” Sens. Ryan Zinke, R-Whitefish, Verdell Jackson, R-Kalispell and Bruce Tutvedt, R-Kalispell, wrote in a column published in the Flathead Beacon in April, as budget negotiations had begun in earnest. “In effect, funds that paid for other programs, such as education, were diverted to pay for Healthy Kids. Without additional revenue, the choice becomes cutting existing programs or raising taxes.”
In the session’s final days, Democrats and Republicans eventually compromised on a budget that implemented the full expansion, which will take effect in October.
Though the dust has settled from the session, Rep. Jon Sonju, R-Kalispell, stands by the Republicans’ position of opposing full CHIP expansion. Sonju agrees with the concept of CHIP, but disagrees with some of the language and mechanisms of the program.
“Basically, there are families that need a handout and CHIP is a way for that, especially in this economy,” he said. But with the voter-approved program expanding access to people at 250 percent of the federal poverty level with no asset test required, Sonju said that leaves coverage open to families who may not necessarily need it – or who prioritize spending on other amenities over providing medical coverage for their children. Parents who may be unemployed but own “more than one house, two boats and 10 four wheelers,” he said, could still qualify for CHIP.
“Before our tax dollars are spent for CHIP, people need to take a look at things such as assets tests,” Sonju said. “Some people need to take personal responsibility out there. What they’re doing is shifting the burden on people who are taking responsibility.”
He also believes government spending on CHIP is just paving the way for so-called “socialized” medicine.
“I will guarantee you this – it’ll be back, maybe not next term or the term after, but they’ll keep raising the (CHIP) threshold up,” he said.
Sonju said he is compassionate toward those who truly need CHIP – people like Ramos, who doesn’t own her home but only has hopes for that kind of financial freedom in the future.
“I wasn’t going to vote against them by any means,” Sonju said. “That is the government’s role, (to take care of) some people that do need a handout.”
But with the politics of CHIP laid to rest, at least until next year’s elections, public health workers in the Flathead can focus on helping kids get medical care. And in October, getting that care will become a lot easier for a few more children.