The House and Senate health care bills are overflowing with proposals that will strip Americans of access to quality, affordable health care. But perhaps the cruelest part is what they do to children — the most vulnerable and powerless among us. Children can’t show up at the ballot box to protect their health and so it truly is up to the rest of us.
Right now, after decades of hard work, the U.S. has achieved near-universal insurance coverage of its littlest residents. About 95 percent of U.S. kids have health insurance. Unfortunately, the House and Senate proposals to replace the Affordable Care Act and gut Medicaid, in combination with Trump’s federal budget proposal, could send the children’s insurance rate tumbling downward. It’s particularly cruel because while there’s no official policy on the books that explicitly guarantees a child’s right to health care, our collective policymaking over the years has tended toward ensuring that children don’t go without timely and necessary medical attention. It’s one of those issues we used to describe as “bipartisan.” (Remember those days?) Today, the health of America’s children sits squarely on the budgetary chopping block, as if their health and well-being aren’t intrinsically connected to all of our future prosperity.
According to a recent report from the Urban Institute, children’s enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) increased nearly one-third between 2008 and 2015, pushing down the child uninsured rate by nearly half. During that time period, children in Medicaid and CHIP experienced improved access to providers and received more routine health care services, while their families faced lower financial burdens related to their children’s medical care. Also in that time span, fewer children went without needed medical care because their families couldn’t afford it, fewer children had to delay care because of cost, and fewer families had problems paying their medical bills. Currently, about 35 million children get their care through Medicaid and CHIP.
However, all that could change if Republican proposals to massively cut and cap federal Medicaid funding as well as cut CHIP become law (more on the Medicaid cuts here). On those GOP policy proposals, Urban Institute researchers Emily Johnston, Jason Gates, and Genevieve Kenney write:
Altogether, these policy changes raise the risk that Medicaid/CHIP eligibility will decline among children, reversing the downward trend in uninsurance that has prevailed over the last several decades. Even if policy changes do not directly target children, changes that reduce Medicaid coverage among parents could still cause a decline in Medicaid and CHIP coverage among children; earlier research has shown that children are more likely to enroll in Medicaid/CHIP when their parents also qualify for public coverage. With less federal funding for Medicaid and CHIP, states may reduce benefits and/or provider payments, which in turn could adversely affect access to care among children covered by these programs. Monitoring is critical to ensure that children, particularly those from low- and moderate-income families, continue to have adequate access to health care.
On CHIP, Trump’s fiscal year 2018 budget proposal “fundamentally restructures” the program, according to First Focus, a nonpartisan children’s advocacy group. In particular, Trump’s budget extends CHIP’s funding through 2019 (its funding officially expires this September), but cuts allotments by $5.8 billion — that’s a cut of 21 percent. That 21 percent cut is achieved through a number of policy changes, including ending the ACA’s increased CHIP matching rates and capping CHIP’s income eligibility. Trump’s budget proposal also calls for cutting Medicaid funding by $610 billion — and keep in mind, that’s separate from the House and Senate health care bills that also cut Medicaid funding by the billions. Just exactly how all these proposals to slash and burn people’s health care will come together remains to be seen, but none of it looks good for kids.
That’s why earlier this month, more than 1,200 organizations from around the country sent a letter to leaders in Congress asking them to save CHIP. They wrote: “It is worth noting that the children who stand to lose CHIP would likely have no other affordable coverage option available to them. The resulting increase in the rate of uninsured children would be an enormous step backwards.”
The most recent health care bill out of the Senate, released just yesterday, would end the ACA’s Medicaid expansion and radically restructure and cap its federal funding. Bruce Lesley, president of First Focus, said of the Senate bill (which is nearly tauntingly titled the “Better Care Reconciliation Act):
There is no way to shield our nation’s most vulnerable children from Medicaid cuts of this magnitude. In fact, contrary to the President’s promise not to cut Medicaid and eliminate onerous regulations, the bill slashes Medicaid by hundreds of billions of dollars out of health coverage and gives states incentives to impose new bureaucracy and red tape barriers to coverage.
For cover, the “Better” Care draft bill attempts to include a few provisions to make the draconian bill appear less harmful to children and families. But, under scrutiny, they will do nothing to prevent the oncoming disaster this legislation would unleash.
Lesley wasn’t the only one opposing the proposal’s treatment of children. Here’s what the American Academy of Pediatrics had to say about the Senate’s supposed carve-outs to protect children:
The bill includes misleading 'protections' for children by proposing to exempt them from certain Medicaid cuts. A 'carve-out' for some children determined to be 'disabled' does little to protect their coverage when the base program providing the coverage is stripped of its funding. Doing so forces states to chip away coverage in other ways, by not covering children living in poverty who do not have complex health conditions, or by scaling back the benefits that children and their families depend on. This bill would make a child's access to health care dependent on his or her ZIP code and force states to make decisions about which vulnerable population gets services. Put simply, this bill is bad policy for children.
The Children’s Hospital Association panned the Senate bill too:
Compared to the (House bill), the new Senate bill calls for even steeper cuts to the Medicaid program by restricting Medicaid’s funding to a slower growth rate. An Avalere Health analysis of the (House bill) concluded that cuts to Medicaid funding for children would be at least $43 billion over 10 years. Ultimately, Medicaid coverage and benefits for the over 30 million children who rely on Medicaid would be threatened in both the House and Senate bills. Congress should not consider any legislation undermining health care for tens of millions of children.
Children’s hospitals across the country call on senators to reject this bill, a bad bill for kids.
The nation’s experts in child health and well-being are trying to warn us: children will suffer if Republicans succeed at defunding Medicaid and CHIP. Adults should listen to them.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.