Last week, U.S. House of Representatives health committees approved a bill to repeal the Affordable Care Act that would put the health of low-income children and children with disabilities at risk unprecedented for more than half a century.
The American Health Care Act is being amended this week to be even more dangerous for children.
The House is scheduled to vote on the amended AHCA on Thursday, March 23. The California congressional delegation should follow the cardinal rule of medicine – first “do no harm” – as they consider any changes to the health care system, particularly those affecting children.
The AHCA does not meet this standard and should be rejected.
Health coverage for children is a smart investment, allowing families to identify and treat conditions before they become more complicated and expensive. Insured children are more likely than uninsured children to be academically successful, graduate from high school, and attend college. In the long run, children covered by Medicaid (known in California as Medi-Cal) grow up to be healthier as adults, earn higher wages and pay more in taxes.
Today, thanks to the ACA, Medicaid, and the Children’s Health Insurance Program (CHIP), 97 percent of California children have health coverage – an historic high. However, the AHCA would reverse that progress and repeal protections that have been in place for 50 years for the nation’s most vulnerable children. The AHCA would shift $370 billion in federal Medicaid costs to states over the first 10 years alone, putting coverage at risk for nearly 37 million children in America – including over 5 million children in California and 59,804 in Merced County. Because almost half of all Medicaid recipients are children, any changes to Medicaid have a disproportionate impact on them.
The Congressional Budget Office has estimated the original AHCA would cause 14 million people to lose Medicaid coverage and drive $880 billion in federal Medicaid cuts by 2026. It would also provide $594 billion in tax cuts to America’s wealthiest individuals and corporations. The CBO has yet to tally the additional damage the amended AHCA would cause.
In addition to the massive Medicaid cuts, it would eliminate Medicaid’s 50-year guarantee of affordable, comprehensive coverage by imposing a “per capita cap” on Medicaid spending that would drastically limit access to health care and coverage for children without reducing their health needs. It also gives states the option to “block grant” Medicaid for poor children, parents and pregnant women that would entail an even lower cap.
It would also give states new authority to cut or eliminate benefits for children (now guaranteed), delay coverage (with waiting lists, currently prohibited), raise cost sharing (currently limited), impose work requirements and limit provider networks. Over time, more costs would be shifted from the federal government to states, counties, local communities, providers and beneficiaries. States would have to cut eligibility, services or both to continue to provide comparable care under the caps.
The AHCA’s new Medicaid cap would disproportionately disadvantage California by locking in 2016 provider payment rates relative to other states in perpetuity, leaving California little or no ability to improve reimbursement rates that are among the lowest in the nation. States that overspend their cap would be penalized the following year.
Any changes that move backwards and make children worse off by depriving them of comprehensive and affordable child-appropriate coverage will jeopardize not only their futures but the nation’s future economic and national security.
The AHCA would destroy Medicaid’s guarantee of coverage for poor and disabled children that has served them well for 50 years, all to pay for another massive tax cut to the wealthy. It does not come close to meeting the “do no harm” to children standard and should be roundly rejected for the sake of California and the nation.
Alison Buist, Ph.D., is the National Child Health Director for Children’s Defense Fund–California, responsible for developing and implementing CDF’s child health policy recommendations. She wrote this for the Merced Sun-Star.