Editor’s note: We at Say Ahhh! are getting a lot of traction around our “top 5s” on Medicaid cuts and the impact of ACA repeal and Medicaid financing changes on child welfare. So we thought we should continue the trend and focus on young children. We are grateful our colleagues at CLASP agreed to join forces on this one.

Leaders in the early childhood community understand that young children need a full system of supports in health, education, and other social services to enter school ready to learn and grow up to reach their full potential. Access to health care is a fundamental need for children, and access for their parents has a significant impact on children’s well-being, too. Congress is actively working to repeal the ACA and radically restructure, or limit, federal Medicaid funding, either through a block grant or per capita cap. Both block grants and per capita caps would limit federal contributions to Medicaid, shifting costs to states and forcing them to make hard decisions about who to cover and where to make cuts. (History shows this is not a great idea.) If passed, both the ACA repeal and efforts to restructure Medicaid could harm young children in the many ways; here are the five most troubling:

1. Many parents and children would lose health care coverage. ACA repeal would mean that the number of uninsured parents and children would more than double by 2019, based on loss of Medicaid expansions, marketplace coverage, and confusion over who does and doesn’t have access to coverage. Restructuring Medicaid and/or failure to extend the Children’s Health Insurance Program (CHIP) would accelerate these coverage losses. Ultimately, ACA repeal and/or proposed Medicaid changes would reverse course on the historic gains in coverage that Medicaid, CHIP, and the ACA have made for children and families. Because parents’ and children’s well-being is so inextricably linked, the loss of access to necessary health and mental health services can have long-term, dire consequences for them both.

2. No guarantee of coverage for all children. Medicaid or CHIP covers 45 percent of all children under 6. Under Medicaid’s current structure, states receive federal contributions for the health costs of any person eligible. A block grant or cap would put a fixed limit on federal contributions, leaving states with difficult decisions about making up the costs by diverting funds from other programs or making cuts to eligibility.

3. No assurance of comprehensive benefits for children. Medicaid’s benefit package for children, known as Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT), helps families afford the care and early intervention their children need to meet developmental milestones. Endorsed by the American Academy of Pediatrics, EPSDT ensures children receive the screenings and treatments to identify and treat delays or diseases as early as possible. For example, catching hearing problems and addressing with a hearing aid has a direct impact on a young child’s success at school. Block grants and caps proposals seek to provide states with more flexibility, meaning they would choose what benefits children can receive and how to spend limited funds. This could likely result in eliminating the federal benefits guarantee that all children have today regardless of the state where they live. Ultimately this means that politicians, not pediatricians, will decide what services are necessary for children’s health and development.

4. Threatens financial security for families and erects new barriers to care. When the burdens of unexpected health problems and related costs are lifted through health coverage, the whole family has greater financial stability. With less federal funding and more flexibility to make cuts, states may impose additional premiums or cost-sharing (e.g., higher deductibles and co-payments) on Medicaid beneficiaries—requiring them to pay more to ensure their children get the care they need.

5. Other state systems that serve young children and their families could take a hit. Medicaid is the single largest federal funding source flowing into state budgets. For perspective, the program represents more than K-12 education, higher education, public assistance, transportation, corrections, and many others combined. Restructuring Medicaid financing through a block grant or cap would shift costs to states, leaving fewer federal, and, ultimately, state dollars to meet the needs of children and their families. Pressure to meet healthcare costs could force states to make cuts in other parts of the budget that impact children, undermining universal Pre-K, education reform, or other proposals. Even as child and family advocates come together to support families, proposals like block grants or per capita caps could pit programs against each other for scarce resources while children and families remain in need.