As we celebrate the good news of the highest health coverage levels on record for children, the latest ACA repeal effort in Congress once again threatens to destabilize the foundation of coverage for our nation’s children. We’ve written before about the ways that structural changes to Medicaid through block grants or caps will harm young children and their families. Graham-Cassidy is no exception.
Medicaid and CHIP cover nearly half of all children under 6, and the ACA’s Medicaid expansion provided coverage to many of their parents for the first time. Graham-Cassidy’s Medicaid caps and an end to the Medicaid expansion would reverse this progress, leaving many more children and their parents without coverage. This impacts the ability to catch and treat children’s developmental delays or health concerns early, through regular screenings and check-ups. (And as early childhood experts know, other programs that states rely on to catch and treat developmental delays, like Part C/early intervention, are already severely underfunded. Exhibit A: Texas)
Parent coverage matters for kids too. The parental welcome mat effect makes it more likely a child will be covered and also supports the parent-child relationships that are critical to children’s healthy development. Parents’ or caregivers’ loss of access to health care could place additional stress on this key relationship through untreated health or mental health problems.
In addition to direct effects, Graham-Cassidy puts stress on other systems that serve young children. This includes financial challenges as states are forced to cut programs to make up for health costs elsewhere, as well as any added pressure that comes with serving children and families with diminished access to healthcare.
This pressure on other child-serving systems brings with it a larger ripple effect that should concern all of us who care about young children and their families. In recent decades, national and state lawmakers have increasingly seen the value in supporting young children’s development through Pre-K, home visiting, family supports, and other investments. Part of the attraction for lawmakers is the strong evidence of returns on investment for these interventions— including some due to positive health outcomes. Dismantling Medicaid under Graham-Cassidy threatens to severely diminish the positive impacts these investments can produce.
Even as it dilutes existing investments in young children, Graham-Cassidy would also severely limit states’ ability to try new, innovative approaches to serving young children. This past summer, New York announced a new initiative to prioritize young children in Medicaid through its First 1000 days initiative. Medicaid caps and cuts would make such innovation more difficult, if not impossible, as states would have to prioritize health care basics over new approaches that may require upfront investments.
As Congress considers this partisan proposal that would dismantle the foundation of coverage for children and families, at least two proven and effective investments for young children— the maternal, infant, early childhood home visiting program (MIECHV) and CHIP— will not have new federal funds as of the end of this month. Doesn’t it make more sense for Congress to focus on investments that work rather than unraveling the fabric of young children’s health coverage?