January 20, 2018

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What Happens When CHIP Funds Run Out

One of the central issues of the shutdown battle is the Children’s Health Insurance Program. NPR’s Michel Martin talks with Alabama CHIP Director Cathy Caldwell about the program, which covers 9 million low-income kids across the U.S.

MICHEL MARTIN, HOST:

We’d like to turn now to one of the main issues caught in the middle of the spending battle in Congress – the Children’s Health Insurance Program, also known as CHIP. This program helps state insure about 9 million children whose parents can’t afford health insurance but make too much to qualify for Medicaid. At the moment, the program is operating on a temporary funding extension that’s expected to dry up in March, but several states say they could run out of funding before then. One of those states is Alabama.

And joining us now is Cathy Caldwell. She is the director of Alabama’s CHIP program. She’s speaking to us from Prattville, Ala. Cathy Caldwell, thank you so much for speaking with us.

CATHY CALDWELL: Oh, thank you for having me.

MARTIN: So for people who aren’t familiar with the program, could you just describe briefly, you know, what it does – amplify what I said earlier?

CALDWELL: Sure. The Children’s Health Insurance Program provides health insurance to uninsured children whose family income is above the Medicaid level. Currently, in Alabama, we have over 85,000 children insured in that program.

MARTIN: And how exactly does it work? Does it work like any other insurance program – people can go to the doctor that they want, go to the hospital if they need to?

CALDWELL: Absolutely. We have a comprehensive benefit package that provides a wide array of benefits for many services, including WellCare so children can get their preventive visits. They can get their immunizations. Also, (unintelligible) care certainly can go to the doctor when they’re sick. We cover inpatient. We also cover mental health services, vision and dental – so a very comprehensive benefit package.

MARTIN: One of my colleagues spoke with you in December. And you said then that your state could exhaust CHIP funds in February. If those funds run out, what happens if a kid whose family has CHIP gets sick and has to go to the doctor or to the hospital? What happens?

CALDWELL: And we did receive some additional funding. But we’re still worried that it’s going to run out before too long. What will happen when we exhaust our funding – we will dis-enroll children from the program. Many of those children will become uninsured. So for many, they will probably not be able to access all of the services they need.

If they’re sick, for example, and go to the doctor, they’ll be expected to pay for it out of their own pocket. In an emergency situation, it’s a – you know go to the emergency department or even an inpatient stay – the family will be expected to pay for those services which will be quite expensive. So it’ll create a hardship on the family. And like I said, there will be situations, likely, where the children won’t be able to obtain the services they need.

MARTIN: I’m sure you know now that we’re in a bit of a standoff here and that both the Republicans and Democrats in Washington are accusing each other of holding, you know, the country hostage to this or that program. Many of the Democrats are saying that the Republicans are using this as a bargaining chip to, you know, force them to vote for something – other things that they don’t agree with. I’d like to ask, how is this all striking you where you are?

CALDWELL: I would like to say that there is huge urgency. I think some people look at the numbers and think that if we still have a few weeks of funding, then there’s no urgency. That is absolutely not the case. These are large programs with many children enrolled. And so if in fact funding does not continue, then we have to shut down our programs. It is going to take time and many resources to accomplish that. So we need Congress to act and extend funding. And we really need to get that down this month.

MARTIN: That’s Cathy Caldwell. She is the director of Alabama’s CHIP program. We reached her in Prattville, Ala. Cathy Caldwell, thank you so much for speaking with us. We really appreciate it.

CALDWELL: Oh, you’re very welcome. Thanks for having me.

(SOUNDBITE OF KOLOTO’S “LIFE IN CLAY”)

Copyright © 2018 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Saturday Sports: Gymnasts Testify On Larry Nassar's Abuse

NPR’s Scott Simon speaks with ESPN journalist Howard Bryant about the emotional testimonies against the former doctor of the USA Gymnastics team. How did the abuse remain hidden for decades?

SCOTT SIMON, HOST:

This week, women and girls have been standing up in court to denounce the man who sexually abused them. Dr. Larry Nassar, the longtime national team doctor for the U.S. women’s gymnastics team. Their testimony’s has been heart-wrenching and outrageous. It’s left many reeling and wondering how such blatant abuse could go on for 20 years, how the USA Gymnastics Federation (ph) failed to protect young athletes and if Michigan State University covered up the complaints against Larry Nassar. We turn now to Howard Bryant of ESPN and ESPN the Magazine.

Howard, thanks very much for being with us.

HOWARD BRYANT: Good morning, Scott.

SIMON: I know we’ve both been watching the court proceedings. What did these women say? What did it mean for them to be able to confront this man?

BRYANT: Well, I think it’s very important for them to be able to confront Larry Nassar, especially in a public forum because this is their life. As we always talk about with sports, this is our entertainment. But this is something so heinous that they’ve had to deal with – and not just Aly Raisman or Simone Biles or some of the other women that have come forward – or Gabby Douglas – that have said that they’ve been victims of Larry Nassar but also all of the athletes that have come before because this has been going on for 20 years…

SIMON: Twenty years, yeah.

BRYANT: …I think. And so I think Aly Raisman – her testimony yesterday was incredibly powerful, where she looked at him and told him he was nothing and that they were a collective and that this was finished for him. But to me, Scott, one of the big things that bothers me about this is, why was this their responsibility? There’s no question that you give them credit for their courage in stepping forward. But how did this happen? And how, when you look at this, how did it go on for so long? And the – and we’re still even asking the question as to if there were problems with the structure. Of course there were problems with the structure.

SIMON: You mean the structure of the…

BRYANT: Of USA Gymnastics and with Michigan State and Karolyi Ranch and all of the particulars where the adults are supposed to take care of these athletes, are supposed to protect them.

SIMON: Yeah.

BRYANT: And it’s no different than any other scandal. When you’re thinking about – whether it’s church or concussions or the rest of it, you cannot allow – and you and I spoke about this a couple of months ago – that you allow the bad guy to go to jail and you leave the structure intact.

SIMON: Michigan State University announced – the board of trustees said they’re – I guess an investigation is going to begin about what might have been a cover-up lasting for 20 years. My question would be, why did they wait so long? Not only why did they wait for 20 years but why did they – Larry Nassar has been under scrutiny for some time now.

BRYANT: Yeah. Well, I think that one of the reasons is for that thing. This is a very American thing that we do. We find the bad guy. We take the bad guy. And we punish the bad guy. And then we leave every mechanism that allowed the bad guy to exist and that enabled the bad guy – we leave those things alone. And Lou Anna Simon, the president of Michigan State, there are calls for her to resign right now. Clearly over some length of time of an investigation, you’re going to have to find some impropriety with somebody other than Larry Nassar. He couldn’t have done this all by himself.

SIMON: Yeah.

BRYANT: And so this is one of the things that we have to deal with as a culture because we don’t deal with it very well and especially when you’re dealing with young people. Joan Ryan, years ago in San Francisco, wrote a fantastic book about a lot of the abusiveness, you know – “Little Girls In Pretty Boxes” back in 1995. And there are plenty of books on this subject.

But it’s simply that we look at gymnastics in similar ways that we look at football and some of these other sports – is that it’s our entertainment and we don’t want to pay attention to what they go through to become elite athletes and all of the possible improprieties that can go on that ended up becoming reality.

SIMON: Howard Bryant of ESPN, thanks so much for being with us.

BRYANT: Thank you.

(SOUNDBITE OF IKEBE SHAKEDOWN’S “THE WAY HOME”)

Copyright © 2018 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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How America Has Changed During Trump's First Year In Office, By The Numbers

Saturday marks the first anniversary of President Trump’s inauguration.

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Over President Trump’s first year in office, the U.S. underwent some changes that he would probably cheer. The economy continued strengthening (including, yes, the stock market, as the president likes to emphasize) and the number of people apprehended while trying to enter the country illegally fell sharply. However, some changes are less promising: The nation’s carbon dioxide emissions rose, and the amount of student debt grew by $47 billion.

We have put together a wide variety of statistics to show how the U.S. has changed in the past year.

Although we’re looking at how the country is changing throughout the Trump presidency, this isn’t to say that the president created these outcomes. Wages, for example, are determined more by worker supply and demand than by the ripple effects of who is in the White House. Still, having a firm picture of the world the president is governing in and the direction it is moving is important for understanding the context in which he makes some of the most important decisions in the world.

Economy

The economy has continued to improve under Trump, with the unemployment rate falling from 4.8 percent to 4.1 percent, and GDP growth ticking upward. The stock market has likewise risen quickly (though those gains largely go to richer Americans). However, wage growth remains middling and has caused some economists to wonder why a tightening labor market hasn’t budged this number much yet.

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Environment

The global environment continues to trouble climate scientists and experts. Projected U.S. carbon dioxide emissions are nearly 15 million metric tons higher than they were a year ago. And while the global temperature average isn’t as above the 20th century average as it was in 2016, it still indicates that the world has warmed considerably in recent years.

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International affairs

There were a few bright spots on the foreign policy front in 2017: The United States and Russia both dialed back their numbers of nuclear weapons, bringing the global total down, and the number of “free” countries (as scored by nonprofit Freedom House) increased by one. However, North Korea also conducted another nuclear test, and the number of forcibly displaced people increased.

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Health policy

Trump never got to sign a health care overhaul bill that repealed the Affordable Care Act (also known as Obamacare). But he did sign a tax bill that eliminated the penalty for not having insurance — the mechanism for enforcing one of Obamacare’s most important parts, the individual mandate. That won’t go into effect until 2019, and it could mean millions more uninsured in the coming years, according one estimate. However, the health care picture in America already is less than rosy — premiums continue to rise, as do the shares of those premiums that workers have to pay.

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Health outcomes

Many health outcome indicators (like life expectancy and the obesity rate) lag by a few years, so we can’t tell how Americans fared on those in the first year of Trump’s presidency. But a few of the stats we do have show that America’s kids are, at least in two areas, engaging in fewer risky behaviors than in 2016. The share of teens who have ever been drunk or smoked a cigarette dipped in 2017, though the share who have used illicit drugs climbed slightly.

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Politics

2017 was an off year, so there are no major changes in the numbers of Republicans in office. But some of those small changes came with big attention — the number of Republicans in the Senate ticked down by one this year, with Alabama Democrat Doug Jones replacing Republican Jeff Sessions, who left the seat to become attorney general. Meanwhile, the resignations of three House Republicans and one Democrat shifted the numbers slightly in that chamber (many more have announced their intention to retire in 2018). Meanwhile, data suggest that Americans became slightly less Republican this year and slightly more Democratic and independent.

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Immigration

One of Trump’s main campaign promises was to crack down on immigration, and on two counts, immigration has fallen. Trump reduced the number of refugees admitted, bringing that figure down significantly in 2017 from one year prior. And the number of apprehensions of people entering the country illegally at the southwestern border has fallen off in a huge way. That’s in part because the Trump administration has focused heavily on enforcement. In addition, improved economies in Latin America give fewer people with reasons to leave, according to the Bipartisan Policy Center.

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NPR’s Rebecca Hersher, Hannah Bloch, Alison Kodjak, Joel Rose and Richard Gonzales contributed to this report.

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