Contemporary Pediatrics

By: Laird Harrison

With the presidential elections coming up, there’s a lot of pressure and tension with the effect that the government will be having in regards to children’s health. Professionals in the health and public health field, such as Irwin Redlener, MD, and Joan Alker, MPhil, mentioned how important these elections are for the children’s health status, and for Medicaid and CHIP programs that have aided poor families in covering their children’s health insurance.

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Both programs pay for healthcare costs for children whose families are in poverty, and together they have improved children’s health, says Joan Alker, MPhil, executive director of the Georgetown University Health Policy Institute, Washington, DC. “There’s a lot of research coming out showing the health benefits for kids,” she says, “and the benefits continue to accrue even when they’re adults.” She cites lower blood pressure, less use of emergency departments, better high school graduation rates, and better economic outcomes.

Clinton says on her website that she would work to expand Medicaid in these states by making the federal government pick up 100% of the program’s costs. That won’t affect children directly, says Alker, because CHIP already picks up where Medicaid leaves off, insuring children up to at least 200% of the federal poverty line.

However, the expansion of Medicaid has indirectly brought healthcare coverage to some children because not all of those eligible for CHIP are enrolled. Sometimes, when parents gain coverage they sign up their children as well, Alker says.

In practice, Alker and other analysts interpret this to mean that overall Medicaid funding would be reduced. “[Trump’s] proposal doesn’t have a lot of detail, but there really has never been a block grant proposal that doesn’t include substantial cuts,” she says “and reimbursement for providers would probably be one of the first things on the chopping blocks for states.”

Simply repealing the ACA would reduce the number of insured Americans by 19.7 million, according to the Rand Corporation analysis. The analysis did not break down the effects by age group, but Alker estimates that about 1 million children are currently insured through the insurance exchanges set up by the ACA. Children are underrepresented in the exchanges compared with the general population because so many are covered by Medicaid and CHIP, she says. 

Charging premiums reduces enrollment by low-income families, Alker says.

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