New House Healthcare Bill Would Harm Medicaid, and Thereby, Child Health Coverage


(Washington, D.C.) – In response to the release of the American Health Care Act by Republican leadership in the House of Representatives last evening, a bill that would repeal major provisions of the Affordable Care Act (ACA) and impose a per capita cap on the Medicaid program, First Focus Campaign for Children (FFCC) releases the following statement by President Bruce Lesley:

The American Health Care Act would, as currently written, be a major step backwards for our nation’s children. The uninsured rate for children reached a record low of 4.8 percent in 2015 and has dropped by 68 percent since passage of the Children’s Health Insurance Program two decades ago. As a nation, we have made enormous progress in terms of ensuring our nation’s children have health insurance coverage. Now is not the time to reverse this progress; the American Health Care Act would seriously threaten the health and well-being of millions of children.

First and foremost, FFCC strongly opposes the provisions in the bill that impose a per capita cap upon the Medicaid program, which currently provides coverage to an estimated 35 million low-income children in this country. Per capita caps are nothing more than arbitrary limits imposed upon states by the federal government that, by definition, shortchange states for the costs associated with care for children with special health care needs, such as children with cancer, spina bifida, cystic fibrosis, asthma, and sickle cell anemia, or other higher-cost populations such as newborns and children in foster care. It is the care to these vulnerable groups of children that could be threatened and rationed by the federal imposition of a per capita cap on states.

In fact, since the entire purpose of a per capita cap is to cut federal support to Medicaid, states may be forced to either finance any shortfall themselves or implement various forms of rationing, such as making cuts in coverage, benefits, and payment rates to provides, shifting more costs to low-income families, or limiting access to care for children, pregnant women, adults, people with disabilities, and senior citizens. This could be an outright disaster for millions of our nation’s most vulnerable citizens.

Although the American Health Care Act retains the provision in the ACA that allows children to stay on their parents’ health care to age 26, which we support, it phases out parallel language that allows children in foster care to retain their Medicaid coverage to age 26 through presumptive eligibility. Children aging out of foster care are some of our nation’s most vulnerable young adults with health care needs associated with their childhood trauma that threaten their well-being. Now is not the time to impose greater administrative burdens and delays on their health coverage, while also underfinancing the care of all children in–and who have aged out of–foster care through the Medicaid per capita cap.

These provisions also violate a campaign promise by President Donald Trump to not cut the Medicaid program and to ensure that no one would lose health coverage under the bill.

As for the changes made by repealing the tax subsidies in the ACA and replacing them with a different set of tax credits in the individual market, FFCC is concerned that such changes may leave children with special health care needs particularly vulnerable. Unfortunately, the legislation currently does not include a much-needed score by the Congressional Budget Office (CBO) along with an analysis of how the bill might impact existing coverage.

Congress should commit to “do no harm” to the health insurance coverage upon which our nation’s children rely. Since this bill threatens to do real harm to Medicaid coverage that an estimated 35 million count on for their care, we urge Congress to return to the drawing board, schedule congressional hearings to discuss and receiving input on health care reform proposals, allow Members of Congress and the public ample time to read and study the legislation, and wait until the CBO does its job in providing a score and analysis of how the bill would impact coverage rates and our nation’s health care system. Children deserve better than to have adults in Congress threaten their health coverage.


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