Early this morning the Senate passed its fiscal year 2017 budget, with a vote of 51-48. The budget now heads to the House for consideration and a vote, which is expected tomorrow. But what does the budget say, and more importantly, what does it mean for children and families?
The budget establishes funding levels for the entire federal budget for FY 2017 and sets broad budgetary levels for the next ten years. It does not contain much detail in the way of policy, but rather lays out overall funding levels for various budget “functions,” including health. The FY 2017 budget also includes reconciliation instructions directing key health care committees in the House and Senate to submit deficit reduction legislation by January 27, 2017. Because the budget includes these reconciliation instructions, Republicans in the Senate will now have the power to repeal the ACA through a simple majority vote rather than the 60-vote threshold typically required.
Truthfully, the budget is largely about process. It does not become law and is technically non-binding. The real work of federal budgeting comes later – typically in the form of appropriations bills. But as anyone who has worked in a bureaucracy of any sort knows, process matters. And this year, process matters a lot – the passage of the fiscal year 2017 budget sets in motion the process of repealing the ACA.
Like the budget itself, amendments to the budget are non-binding and primarily used as tools of political messaging. But they can help shed light on how Senators are thinking about the impact of proposals that are expected to be under consideration soon, like repealing the ACA.
Perhaps of most relevance to children, Senator Brown (OH) offered an amendment to protect the historic coverage gains for children in the US going forward. The amendment failed 49-49, with all Democrats present supporting it and Republican Senators Collins (ME) and Heller (NV) also in support. Senator Menendez (NJ) also offered an amendment to preserve the ACA’s Medicaid expansion, which failed 50-48. Thirty-two states have adopted the Medicaid expansion to cover more parents and other adults, and we know that these coverage expansions have helped more previously eligible children gain coverage too.
So what does the budget mean for children and families? The budget itself may not shed much light, but the true mission of the FY 2017 budget is clear – it is to set up reconciliation so that Republicans can repeal the ACA. And we know what repealing the ACA means for children and families. As readers of Say Ahhh! already know, parents would lose coverage, which would lead to children losing coverage and jeopardize the financial security of the whole family. States would also be allowed to roll back Medicaid and CHIP eligibility levels for children, reversing the gains we’ve made covering 95% of children today. With all of the policies taken together, ACA repeal would cause the number of uninsured children and parents to more than double.
This morning’s vote may seem to be of little consequence, but the fact of the matter is that it sets in motion the repeal of the ACA and other Medicaid changes that would lead to millions of children losing the protections Medicaid affords them today – a guarantee of coverage, a benefit that meets each child’s health care needs, and cost sharing limitations that make services affordable for low-income families.