Families that benefit from the Children’s Health Insurance Program (CHIP) let out a sigh of relief on January 22 when the program they rely on for health insurance was reauthorized for six years. While the greater healthcare community was equally pleased to see CHIP reauthorized, proponents of lesser known programs that contribute to the healthcare system now fear they may have missed the boat.

When it comes to federal legislation, transportation analogies do apply to healthcare programs. The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, which offers voluntary, evidence-based home visiting for at-risk families with small children, and the community health centers, where many CHIP recipients receive their care, are just two of the lower profile programs that have historically “traveled” along with the CHIP “vehicle.”

Why do some federal programs rely on others to carry them through to reauthorization?

For starters, there is simply not enough time for Congress to formally consider every federal program up for reauthorization through regular order. Congress is tasked with funding the federal government, finding new solutions to problems that arise nationwide- such as the current opioid crisis- and reacting to unforeseen events both domestically and around the world, in addition to thoughtfully examining and updating existing laws.

To add to that challenge, Congress must find consensus between its upper and lower chambers, a task that has become increasingly difficult. For that reason, and many others most of which are related to the political climate, Congress tends to pass packages of legislation rather than individual bills. Large or popular programs, such as CHIP, become the focal point of the legislative effort. Smaller programs become bargaining chips during the negotiation process. Historically, programs such as MIECHV were considered “sweeteners” in a broader health extenders package because of bipartisan support for the program from influential Members of Congress.

Last month, CHIP became the “sweetener” in a continuing resolution to keep the government funded. This turn of events- using a large and popular program to negotiate in favor of an unpopular spending tactic- has created a stir in the health policy world because it has taken away the opportunity for other programs to hitch a ride with CHIP. Now proponents of MIECHV, the community health centers and their counterparts have been left searching for another vehicle to travel with.