Nation’s Progress on Children’s Health Coverage Imperiled

On November 9th I blogged about what the election results could mean for child and family coverage. As readers of Say Ahhh! know, the nation made extraordinary progress in reducing the rate of uninsured children to under 5%, This progress is thanks to Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act (ACA). All three legs of that coverage stool are now clearly imperiled.

Yesterday the House of Representatives passed a bill that will lead to at least 24 million more uninsured people in the U.S. in a decade. The approved measure calls into question the future of marketplace coverage. While a relatively small number of children are enrolled in marketplace plans in comparison to other sources (approximately one million kids are covered in the marketplace) it provides an important source of coverage for their parents and caregivers. Children rely on healthy parents and caregivers, so rolling back coverage for adults will have a direct impact on children’s health and well-being. When even one member of the family is uninsured, it puts the entire family at risk of medical bankruptcy. And the repeal of the individual mandate itself will almost certainly have a chilling effect on the “welcome mat” effect that we have seen as an important component of recent improvements in children’s participation rates in Medicaid and CHIP.

For children, the most significant threat in the American Health Care Act (AHCA) is the elimination of the current guarantee of coverage through the Medicaid program. The bill approved by Congress would cut more than $800 billion from Medicaid and jeopardize coverage for children, people with disabilities and others who rely upon it to meet their health needs. Medicaid provides a particularly important lifeline for children with special health care needs. It allows parents of children like Caroline, who has Rett Syndrome, to care for their children in their homes. In fact, Medicaid has formed the backbone of the public coverage system for children for more than 50 years and about half of all Medicaid beneficiaries are children.

While little discussed in the media (relative to other provisions in the bill), the AHCA imposes a per capita cap on the entire Medicaid program. Imposing an arbitrary cap on federal Medicaid funding would put states at greater risk when health care costs increase in the future such as increases in the cost of Epi-pens and other needed prescription medications. States would be left to make up the difference by increasing state and local taxes, reducing provider reimbursements and cutting health care for people who need it. Children make up the single largest group of Medicaid beneficiaries and there is no way to cut Medicaid without harming kids and the providers that they turn to when sick or injured such as pediatricians and children’s hospitals.

That brings me to the third leg of the stool – CHIP. About 9 million children rely on CHIP funding to meet their health needs. For two decades, CHIP has been a lifeline for families who earn too much to qualify for Medicaid but not enough to afford private insurance. CHIP and Medicaid are designed to work together to meet children’s health care needs. In fact, CHIP is a success because of Medicaid’s ability to cover kids from the lowest-income families – and many kids on CHIP are in a Medicaid expansion financed by CHIP.

CHIP builds on the solid foundation of coverage for our nation’s children and families established by the cost-effective Medicaid program. Together, they have achieved historic progress for children by bringing their uninsured rate to an all-time low. Today that progress is at serious risk as Congress faces monumental decisions that would preserve or undermine children’s health coverage.

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.