A new report by leading child health economists at the Urban Institute models a partial repeal of the Affordable Care Act (ACA) through reconciliation and its impact on children and parents. The study found that the number of uninsured children would more than double under a partial repeal as compared to current law: an additional 4.4 million children ages 18 and under would become uninsured by 2019. The percent of uninsured children would rise to 9.6 percent – more than twice as high as projections for 2019 under current law (4.1 percent). As regular readers of Say Ahhh! know, currently children’s coverage rates are at a record high of 95 percent.
The report also finds that parent coverage is at risk with an estimated 7.6 million more uninsured parents in 2019 under a partial repeal of the ACA – an increase of 113 percent. The uninsured rate for parents would rise to 22.8 percent by 2019 as compared to 10.7 percent if the ACA were maintained.
Eighty-eight percent of children losing coverage under partial repeal would be from working families and 900,000 of the children losing coverage would be under the age of 5. The majority (54 percent) of the children losing coverage would be white. More than 85 percent of parents who would lose coverage are working full or part-time. State-by-state projections on coverage losses for both children and parents are included in the report.
Numerous studies have found that access to health insurance results in better health as well as improved educational and economic outcomes for children when they grow up. Fundamentally, having health coverage is an important economic protection for families, with medical debt a leading cause of bankruptcy. When one person in the family loses health coverage (child or parent), it impacts the entire family and adds stress and financial burdens that accompany unpaid medical bills and unmet health care needs.
There are many important decisions facing the next Congress with respect to coverage for children and families. Funding for the Children’s Health Insurance Program (CHIP) runs out on September 30, 2017 so Congress must act to extend funding. The new report looks at some additional scenarios including the consequence of inaction by Congress on CHIP. The model assumes that if CHIP funding runs out, states that operate “separate” state CHIP programs will eliminate those programs (because no federal funds would be available) and those that operate their CHIP programs through Medicaid would not (because they would continue to get Medicaid match). This may be an overly optimistic assessment but it is hard to predict state behavior.
Congressional inaction on CHIP would be especially devastating for children were it to follow a repeal of the ACA as there would be no marketplace coverage for children to fallback upon. The report finds that an estimated 3.7 million additional children would lose coverage under this scenario with the uninsured rate rising to just over 14 percent.
Finally, Urban researchers examined the impact of repealing the “maintenance of effort” (MOE) provisions on income eligibility levels for children in Medicaid and CHIP. For more about the importance of this wonky provision see our report. The MOE has played a vital role in preserving the stability of children’s coverage at a time of much change. Currently, the maintenance of effort provision is in effect until 2019, but the 2015 partial repeal of the ACA bill would have eliminated the MOE in 2017 – two years early. This suggests that the MOE’s future does not look bright.
It is hard to know what states would do in the absence of the MOE, and even more difficult to assess the impact without having full knowledge of the federal funding available for Medicaid and CHIP – since both are likely to be on the chopping block. Urban researchers estimated the impact of states pulling back to current federal minimum coverage levels for kids and found very dramatic results. They projected a further increase of uninsured children of 9.5 million with just over one in five children in the U.S. being uninsured – a return to levels this country has not seen since before CHIP was enacted.
 A recent report by Urban researchers that I blogged about found a slightly smaller increase in the number of uninsured children. Both used the same model but today’s report looks at kids age 18 and under whereas the previous report looked at children 17 and younger.