Health Proposal Breaks Long-standing Bipartisan Commitment to Children’s Health

With virtually no time to unpack the provisions in the Manager’s Amendment that was released late Monday night and no CBO score expected until just before the vote, it appears that the House is on the verge of voting to repeal not just the Affordable Care Act, but also break the long-standing bipartisan promise of affordable, comprehensive coverage for kids.

This promise relies on Medicaid as its foundation, and predates the Affordable Care Act.  Years of progress have resulted in a historic achievement of 95% of kids covered in 2015. I am somewhat of a cynic but I was taken aback reading the provisions of the amendment that targets kids and their families for harm while Congress is repealing the ACA. Let’s review what is in the plan being considered by Congress:

A new block grant option is created for states that allows states to include children, parents, and pregnant women and eliminates current enrollment, benefit and cost-sharing standards. States may not include elderly and disabled persons (presumably to protect them in the eyes of the drafters) in the block grant – they however remain at risk under the per capita cap included in the bill. Both a block grant and a per capita cap represent a radical restructuring of Medicaid’s financing structure that has been in place for over 50 years, but the block grant option for kids, parents, and pregnant women is even worse.

In states that take up the block grant option, children will no longer be guaranteed the EPSDT benefit, which has been in place for decades to ensure that kids are able to access needed screenings and treatment.

The EPSDT benefit ensures that each child is covered for individualized screenings and treatments, but under the block grant option in the House plan, EPSDT is no longer required. That means the Governor and/or the state legislature would decide what benefits a child would get, not the child’s pediatrician.

You may have heard HHS Secretary Price and others in the GOP say that they believe the doctor-patient relationship is sacred and government should not interfere. Apparently they don’t hold that belief when it comes to our nation’s most vulnerable children.

Current cost-sharing protections for children are wiped out here too. Enrollment caps and freezes would be allowed as well. States could create narrow provider networks, eliminating high-cost providers or those providers unwilling to accept lower and lower rates. In short, in states choosing a block grant approach, children will lose virtually all of the current federal protections they have.

This is not a theoretical discussion as last weekend Vice President Mike Pence appeared with Florida’s Governor Rick Scott, who loudly proclaimed that he would like a block grant. Texas is another state that may go down this path. That is a lot of children, pregnant women and parents that may lose the guarantee of coverage our country has promised them for decades – like millions.

Many parents will become uninsured. Many of you don’t need reminding of why it is so important for parents to be covered, but if you want a refresher, read our new factsheet. To state the obvious a healthier parent is a better parent. And one uninsured family member exposes the whole family to financial insecurity.

In any event, the House GOP bill does not agree with me on the importance of parent coverage. While precise numbers cannot be ascertained in such a short timeframe (isn’t that the point!), it is clear that millions of parents will lose coverage.
Beginning in 2020, states will receive far less funding for parents who gained coverage because of the ACA’s Medicaid expansion as fewer and fewer parents qualify for the expansion match. This would jeopardize their coverage as states are already being forced to stretch less and less federal money under the bill. Also beginning in 2020, states could switch their parent coverage to the block grant option and under that option, states could scale back parent eligibility or eliminate it completely – even for so-called “mandatory 1931” parents.

In addition to these new issues, the underlying bill continues to jeopardize children’s coverage by imposing a per capita cap on the entire program which we have blogged about elsewhere. But the latest version of the bill makes a bad situation for children and families even worse.

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.