Washington– Health insurance coverage for nearly one in three people receiving coverage through Medicaid or CHIP could be put at risk if stability protections in the Affordable Care Act are rescinded according to a research report issued today by the Georgetown University Health Policy Institute’s Center for Children and Families. The report also highlights the impact on Americans if
states employ “backdoor” methods to keep people out of coverage by increasing red tape, a strategy that can have the same effect as directly cutting people off coverage and one that close to half of the states employed during the last economic downturn.
“Repealing the stability protections could unravel the country’s successful efforts to keep children covered and would hit families just as they are regaining their footing after turbulent economic times. Nearly twice as many children are at risk as any other group,” said Jocelyn Guyer, an author of the report and co-director of the Center for Children and Families. “If the protections are removed it will make it harder for seniors to stay in their own homes because long-term care for seniors, including home and community-based care, is covered not through Medicare but through Medicaid.”
“A number of the governors who are calling for the repeal of the stability protections are also calling for tax cuts, sitting on substantial rainy day funds or both,” Joan Alker, co-director of CCF and an expert on Medicaid policy. “State leaders will have to make difficult decisions, but they have options.”
The report, “Eliminating Medicaid and CHIP Stability Provisions (MoE): What’s at Stake for Children and Families,” examines who is most at risk of losing coverage if key protections are rolled back. The report focuses in detail on the potential impact on children, parents and pregnant women, but also considers the implications for seniors and people with disabilities.
Key Findings include:
The coverage of more than a third of Medicaid and CHIP beneficiaries is at risk if the stability protections are rescinded. Overall, 35 percent of all Medicaid and CHIP beneficiaries are covered at state option, including 14.1 million children; 8 million parents, pregnant women and other non-disabled adults; 2.8 million low-income seniors; and 2.3 million people with disabilities.
Even people who remain eligible for coverage will be vulnerable to cuts through “backdoor” strategies. If the stability protections are rescinded, states can re-introduce red-tape barriers to coverage. While not as obvious as reducing eligibility levels, these “backdoor” strategies for depressing enrollment can be just as effective at cutting coverage. Close to half of states adopted this strategy during the last recession and many experienced marked drops in enrollment as a result.
The nation’s progress in covering children could unravel. Through Medicaid and CHIP, the country has successfully driven the uninsured rate of children down to the lowest level on record. This progress could quickly unravel if states freeze enrollment in their CHIP programs or add new red-tape barriers to coverage, as occurred during the last recession.
States have a range of alternative choices for tackling Medicaid budget pressures. There are a variety of options available to governors to address budget issues without unraveling Medicaid and CHIP. Those options include: tapping rainy day funds or raising revenues; using the significant flexibility states retain within Medicaid to achieve savings without eliminating coverage; and turning to health care providers to help finance more of the share of state spending on Medicaid.
The full report is available here.
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