It seemed like a lost cause. But in May, as the result of six years of hard work by the AAP Arizona Chapter and numerous other advocates, Arizona got its Children’s Health Insurance Program (CHIP) back.
In 2010, Arizona became the only state in the nation without a CHIP program, known in Arizona as KidsCare. The state had frozen enrollment in the program weeks before the 2010 passage of the Affordable Care Act, which included a provision that prohibited states from restricting Medicaid and CHIP eligibility or enrollment. Following the freeze, KidsCare enrollment dropped significantly, and the program effectively was dismantled. A temporary KidsCare II program was instituted in 2013, but it expired in January 2014, leaving children in the state without CHIP coverage again.
In May, legislation was enacted to reinstate the program just before state Legislature adjourned. KidsCare is slated to begin accepting applications this month, and coverage is to begin Sept. 1. Children with family incomes up to 200% of the federal poverty level are eligible. Up to 30,000 Arizona children are expected to gain affordable health care coverage through the program.
“Frankly, it’s an enormous achievement,” said chapter President Delphis C. Richardson, M.D., FAAP. “We couldn’t be more delighted.”
Having worked to reinstate CHIP since 2010, the chapter and a coalition of child and family advocates saw the 2016 legislative year as promising for KidsCare. Federal legislation reauthorizing CHIP spending recently was enacted and included a 23 percentage point increase in federal CHIP dollars. But even with this increased federal funding, which made the program cost neutral for the state, reviving KidsCare in Arizona would be challenging.
In early March, the bill to reinstate KidsCare passed the state House but was quickly held up in the Senate by opponents. Subsequently, supporters in the Legislature decided not to include KidsCare in the state’s delicate budget negotiations. So for a time this spring, it seemed that Arizona’s children would have to wait another year for the chance to see their coverage restored.
Advocates continued to work behind the scenes and just before the Legislature’s adjournment, legislators attached the KidsCare reinstatement to another piece of legislation, which sailed through both houses with bipartisan support. Arizona Gov. Doug Ducey signed the bill into law on May 6.
“The advocacy message is to be persistent,” said Mary Ellen Rimsza, M.D., FAAP, chapter board member and chair of the chapter’s advocacy committee. “Having legislation enacted is a marathon, not a sprint, but it can be done!”
The chapter’s advocacy marathon began when the chapter and countless other advocates, including the Children’s Action Alliance of Arizona, established the “Cover Kids Coalition” to resurrect KidsCare.
“Teamwork among organizations is really key,” said chapter Vice President John A. Pope, M.D., M.P.H., FAAP. “Finding a group of active partners made all the difference — we had such a diversity of groups, some not even child-focused, advocating to bring back CHIP.”
Advocacy strategies included raising the issue at the Legislature, during legislative budget forums and at town halls across the state. The chapter and other advocates held press conferences, issued media releases and sent email blasts to encourage members to call and write their lawmakers.
“There wasn’t a meeting where we didn’t have a pediatrician advocating for KidsCare,” Dr. Rimsza said.
When the Legislature held hearings, the chapter was there, too. Chapter board member Elizabeth H. McKenna, M.D., FAAP, testified, highlighting her experience caring for children who would be CHIP-eligible but were uninsured or covered by marketplace plans that didn’t work well for kids.
“We knew that children were going without insurance, and we knew families with marketplace plans were avoiding care because of higher deductibles and fewer benefits. We saw that directly in our practices,” Dr. McKenna said. “Telling our stories to the Legislature put even more of a human face on the importance of KidsCare.”
Lawmakers were listening, and data corroborated pediatricians’ experiences. In recent years following the end of CHIP, the state maintained a children’s uninsurance rate of 10.5%, compared to a national average of just over 6%. Meanwhile, Arizona children comprised 23% of the state’s marketplace plan enrollees, compared to an average of only 9% nationally.
“Reinstating KidsCare would clearly help the children of Arizona, and with so many organizations advocating on the same issue, lawmakers were responsive and we congratulate them,” Dr. Richardson said. “We are looking forward to a brighter tomorrow for children in our great state.”
