Arizona’s Coverage for Children and Families is Especially Threatened by ACA Repeal with No Replace

Congressional leaders have been clear that a repeal of the Affordable Care Act (ACA) is first up on their agenda in January. I blogged about this the other day, and as I was reflecting on these issues, I realized that children and families in Arizona are in particularly hot water if the ACA is repealed. Here’s why:

Arizona is one of 31 states that has expanded Medicaid for parents and childless adults through the ACA option. Current enrollment stands at over 425,000 according to Arizona’s Medicaid agency and a straight repeal would withdraw a whopping $3.2 billion from Arizona’s economy as well as (to state the obvious) eliminate coverage for those adults.

Along with those who are receiving ACA funded Medicaid coverage, there are approximately 200,000 who are insured through the marketplace in Arizona – three quarters of whom are receiving tax credits to do so. That means over 600,000 people stand to lose coverage in Arizona if the ACA is repealed, so perhaps not a huge surprise that concern about repealing the ACA with no replacement plan was expressed by Arizona’s Republican Governor Ducey very shortly after the election.

Arizona has an unusually large number of children in the ACA marketplace. The most recent data show that almost 47,000 kids are enrolled in marketplace coverage. Children comprise 23 percent of enrollees in the AZ marketplace, which is much higher than the national rate of 8 percent. In fact, Arizona is tied with North Dakota and Utah for the highest proportion of children enrolled in marketplace plans. That probably has something to do with the next point, which reflects on Arizona’s on- again, off-again commitment to its Children’s Health Insurance Program (CHIP).[1]

Arizona reopened its KidsCare program in July and this coverage could be at risk as Congress takes action on the ACA, CHIP and Medicaid next year.

Regular readers of SayAhhh! know that for several years Arizona was the only state in the country without an active CHIP program. As we wrote about here, Arizona has one of the nation’s highest uninsured rates for kids and the state has been a real outlier with no CHIP program. So last spring, the legislature finally responded to an outpouring of support for uninsured children and moved to reopen KidsCare. You can read about how that happened here. Enrollment began in July, and so far almost 10,000 kids have signed up.

But the state authorizing statute included a provision that said enrollment could be closed if the state determined that funds were insufficient to run the program. The U.S. House Energy and Commerce Committee (the committee with jurisdiction over Medicaid and CHIP) passed the Common Sense Savings Act of 2016, which included a reduction in the CHIP matching rate of 23% — currently authorized in federal law until 2019.

If that measure were to become law, Arizona and other states would see a reduction in their CHIP match rate. Arizona kids would be in even more jeopardy than elsewhere given the state’s history with the program, a cut in the CHIP match would likely trigger another enrollment freeze, or even termination of the program altogether if the state did not come up with more state funding to keep KidsCare open. As in the past, that would lead to more chaos, confusion, and uninsured children. It is in the hands of Congress to address the future of CHIP funding next year as the current funding expires September 30, 2017.

[1] CCF analysis of marketplace enrollment data available here.

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.