American Health Care Act would jeopardize care for children and families

Washington, DC—The American Academy of Pediatrics, Children’s Defense Fund, Children’s Dental Health Project, Family Voices, First Focus Campaign for Children, March of Dimes and National Association of Pediatric Nurse Practitioners issue the following joint statement opposing the American Health Care Act’s (AHCA) drastic changes to Medicaid and their detrimental impact on children and families:

“Our organizations represent children, pregnant women, families, children’s health care providers, hospitals and advocates across the country, and we speak with one voice today to urge the U.S. House of Representatives to keep Medicaid strong for children and vote ‘no’ on the AHCA. This bill ends the Medicaid program as we know it, jeopardizing coverage for the 72 million vulnerable Americans – primarily children, pregnant women, seniors and people with disabilities – who rely on Medicaid for their health care.

“Children make up the single largest group of people who rely on Medicaid; nearly 36 million children receive Medicaid coverage, including children with special health care needs and those from low-income families. Medicaid also provides comprehensive prenatal care to pregnant women, allowing millions of pregnant women to have healthy pregnancies and helping millions of children get a healthy start. Unlike many private health insurance plans, Medicaid guarantees specific benefits designed especially for children. Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits are the definitive standard of pediatric care, covering an array of services like developmental, dental, vision and hearing screenings, and allowing health problems to be diagnosed and treated appropriately and as early as possible. Simply put: Medicaid works. In fact, children in Medicaid are more likely to get check-ups, miss less school, graduate and enter the workforce than their uninsured peers.

“Medicaid is able to provide affordable, comprehensive care for every child because of the strength of Medicaid’s state-federal partnership. The program already provides flexibility to states and allows each state to meet the needs of its Medicaid population when a natural disaster, public health crisis like the current opioid epidemic or economic recession increases the number of people enrolled and the cost of providing services.

“The AHCA includes harmful proposals to restructure Medicaid, and the changes to AHCA unveiled on Monday evening go from bad to worse, allowing even more damaging changes to the program. In addition to the bill’s initial proposal to fund Medicaid through per capita caps, the amendments would allow states to choose a block grant model, which would eviscerate existing protections afforded to children and pregnant women in the Medicaid program. Comprehensive EPSDT benefits would no longer be required for children, allowing states to ration limited dollars by drastically cutting back pediatric services.

“Block grants and per capita caps have a singular purpose, to reduce federal funding to states. In a bill that is supposed to be improving care for Americans, block grants and per capita shift costs from the federal government to the states, putting pressure on states to come up with the resources to cover their Medicaid patients when federal funds run out and costs inevitably rise. These drastic changes would place politicians, rather than health care providers, in charge of health care for children, pregnant women and families. Whether a life-saving childhood vaccination, a wheelchair or a hearing aid, politicians should not be the ones determining who gets what coverage, which providers offer those services, and what families must pay.

“The AHCA does not make coverage more affordable for families. In fact, it makes it harder for families to afford premiums in the individual market and phases out the option for states to expand Medicaid to cover more low-income adults, which has led to tremendous cost savings for states and better health outcomes for families across the country. Having healthy parents means children are healthier, too. Restructuring Medicaid financing, and opening the door to harsh work requirements for Medicaid enrollees, as the AHCA proposes, are not only bad for state budgets, they are harmful to child health.

“The AHCA’s provision allowing states to deny Medicaid coverage unless mothers and fathers are working is especially onerous. This provision would mean that a married, pregnant woman could be required to return to work 60 days after giving birth in order to keep her Medicaid coverage. Maintaining health coverage for mothers after birth is essential for infants’ healthy development. Among adults with Medicaid coverage, about 80% are in working families; this proposal is not only short-sighted and dangerous, it offers a solution to a problem that does not exist.

“In short, our organizations are united in opposition to any threat to Medicaid that would jeopardize the gains we’ve made in children’s coverage and dismantle a pillar program that millions of families rely on. More children are insured today than at any time in American history; the AHCA will reverse that progress. We urge Congress to oppose the AHCA and to instead pursue policies that prioritize children and keep Medicaid strong.”

Earlier today, many of our organizations joined a letter with more than 400 organizations dedicated to improving the well-being of children from all 50 states and the District of Columbia to urge Congress to keep the unique needs of children and their parents front and center as they consider any changes to the nation’s health care system.

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About the American Academy of Pediatrics

The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds.

About the Children’s Defense Fund

The Children’s Defense Fund Leave No Child Behind^® mission is to ensure every child a Healthy Start, a Head Start, a Fair Start, a Safe Start and a Moral Start in life and successful passage to adulthood with the help of caring families and communities.

About the Children’s Dental Health Project

The Children’s Dental Health Project (CDHP) is an independent nonprofit that creates and advances innovative policy solutions so that no child suffers from tooth decay. Based in Washington, D.C., CDHP is driven by the vision of all children achieving optimal oral health in order to reach their full potential. We use data measurement and analysis to advance models that incentivize oral health, not just payment for treating the symptoms of dental disease. CDHP seeks to lead the way toward a health care system that is truly inclusive of oral health, from payment to care delivery. Learn more about CDHP at www.cdhp.org.

About Family Voices

Family Voices is a national, nonprofit, family-led organization promoting quality health care for all children and youth, particularly those with special health care needs. Working with family leaders and professional partners at the local, state, regional, and national levels since 1992, Family Voices has brought a respected family perspective to improving health care programs and policies and ensuring that health care systems include, listen to, and honor the voices of families.

About the First Focus Campaign for Children

The First Focus Campaign for Children is a 501(c)(4) nonprofit organization affiliated with First Focus, a bipartisan children’s advocacy organization. The Campaign for Children advocates directly for legislative change in Congress to ensure children and families are a priority in federal policy and budget decisions. Learn more at campaignforchildren.org and follow on Twitter at @Campaign4Kids.

About the March of Dimes

The March of Dimes is the leading nonprofit organization for pregnancy and baby health. For more than 75 years, moms and babies have benefited from March of Dimes research, education, vaccines, and breakthroughs.

For the latest resources and health information, visit our websites marchofdimes.org and nacersano.org. To participate in our annual signature fundraising event, visit marchforbabies.org. If you have been affected by prematurity or birth defects, visit our shareyourstory.org community to find comfort and support. For detailed national, state and local perinatal statistics, visit persistats.org. You can also find us on Facebook or follow us on Twitter.

About the National Association of Pediatric Nurse Practitioners:

The National Association of Pediatric Nurse Practitioners (NAPNAP) is the nation’s only professional association for pediatric nurse practitioners (PNPs) and their fellow pediatric-focused advanced practice registered nurses (APRNs) who are dedicated to improving the quality of health care for infants, children, adolescents and young adults. Representing more than 8,500 healthcare practitioners with 19 special interest groups and 50 chapters, NAPNAP has been advocating for children’s health since 1973 and was the first NP society in the U.S. Our mission is to empower pediatric-focused PNPs and their interprofessional partners to enhance child and family health through leadership, advocacy, professional practice, education and research. NAPNAP.org

On March 21, 2017, First Focus Campaign for Children sent a letter to Congress to provide comments on the American Health Care Act.

The Campaign for Children strongly opposes the legislation, and urges a "do no harm" approach to the health coverage of children.

The letter details concerns about this legislation's imposition of the Medicaid per-capita caps upon the states and the block grant option.

Read the letter here.

FOR IMMEDIATE RELEASE: March 7, 2017

(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.

FOR IMMEDIATE RELEASE: February 24, 2017

(WASHINGTON, DC) – First Focus Campaign for Children (FFCC) President Bruce Lesley warns in an open letter to all governors this week that proposed changes to Medicaid financial structures would “undoubtedly have negative consequences on the health and well-being of our nation’s children.” Both structures currently under consideration in Congress–a block grant and a per capita cap–would jeopardize children’s health coverage, says Bruce Lesley, president of FFCC.

FFCC president Bruce Lesley writes, “As we contemplate changes to our nation’s health care system, President Trump and Congress should not gamble with the health of our children. They should commit to ‘do no harm’ to state systems of care for children and not propose changes that would undermine or reverse the incredible progress that has been made – whether intended or not.”

Under a Medicaid block grant, federal funding is provided to states based on an arbitrary cap that would fail to adjust for population growth, medical inflation, economic downturn, natural disaster, or an epidemic. States would be left entirely on the hook without any federal financial support as need increases beyond the arbitrarily-imposed limit. In such a circumstance, as the letter highlights, states would have to “choose among a variety of bad options, such as cutting off coverage for children, pregnant women, people with disabilities, or low-income senior citizens; imposing enrollment freezes (which disproportionately harm babies); putting those in need on waiting lists; withholding certain medical benefits; slashing payments to providers; raising taxes; or most likely, all of the above."

In addition to the problems inherent with the federal government setting an arbitrary cap on state funding, FFCC’s letter to the governors also underscores the fact that Medicaid block grant and per capita cap proposals have all been accompanied by hundreds of billions of dollars in programs cuts. These cuts would harm both state budgets and the low-income children, pregnant women, people with disabilities, and senior citizens that rely on Medicaid coverage. Moreover, FFCC points to an analysis by the Center on Budget and Policy Priorities in which they show how block grants to states have historically resulted in declining funding over time.

In the letter, FCC draws a connection between Puerto Rico’s Medicaid block grant and its budget shortfalls which have contributed to their debt crisis. FFCC warns that converting Medicaid to a block grant or per capita cap would be a similar “disaster” for states.

With particular respect to the needs of children, particularly those with special health care needs, FFCC points out that kids would be most likely to bear the brunt of the cuts accompanying Medicaid funding caps. The House of Representatives’ proposed outline released last week reads, “States would have flexibility in how Medicaid funds are spent, but would be required to provide required services to the most vulnerable elderly and disabled individuals who are mandatory populations under current law.” The summary leaves out any similarly expressed protections for children and pregnant women, who account for nearly 50 percent of all Medicaid enrollees and appear to be the group most exposed to cuts.

In addition to the harm that children would be exposed to from billions of dollars in cuts, FFCC also notes that any additional spending from states to make up for potential shortfalls would compete with other programs of importance to children in state budget, including education, early childhood, child welfare, public health, and social services programs.

In closing, FFCC calls on the nation’s governors to adopt a “do no harm” standard and protect the enormous gains that have been made in children’s health coverage over the past 20 years – a drop in the uninsured rate from nearly 15 percent to less than five percent. As the letter reads, “Today, over 95 percent of our nation’s children have health insurance coverage. Now is not the time to retreat from two decades of progress and undermine the health and well-being of our nation’s children.”

The letter continues, “Consequently, we urge you to reject proposals from Congress that would impose either Medicaid per capita caps or block grants upon the states [...] We also urge you to push for the swift enactment of a long-term extension of the Children’s Health Insurance Program. CHIP works exceedingly well, and, over the years, it has proven to be an enormously popular and bipartisan program for children. To ensure that children are not left worse off, action on CHIP is needed as soon as possible.”

Click here for a copy of the letter.

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The First Focus Campaign for Children is a 501(c)(4) nonprofit organization affiliated with First Focus, a bipartisan children’s advocacy organization. The Campaign for Children advocates directly for legislative change in Congress to ensure children and families are a priority in federal policy and budget decisions.

FierceHealthcare

by Leslie Small
2/22/17

The changes to Medicaid funding recently proposed by Republicans could have serious consequences for vulnerable populations and state budgets alike, the leaders of five national advocacy organizations said on a press call Wednesday.

Howard Bedlin, the National Council on Aging’s vice president of public policy and advocacy, said he was “shocked” that such major changes to Medicaid were included at all in the GOP’s outline of policy proposals about how to replace the Affordable Care Act, given both are separate issues.

Regardless, the two Medicaid funding options floated by the GOP—block grants and per capita caps—“would lead to unprecedented cuts in Medicaid spending,” he said.

Thus, he and the other leaders on the call said they planned to urge governors attending the National Governor’s Association Winter Meeting to push Congress to reconsider the cuts.

Read More...

Nearly half of infants and toddlers in the U.S. are living in low-income families. This means that over 5 million young children are living in families that have a hard time covering the cost of their family’s basic needs, including diapers for their young children. The Hygiene Assistance for Families of Infants and Toddlers Act of 2017 (H.R. 1143) will give states flexibility in developing and implementing their program.

(WASHINGTON, D.C.) – Amid discussions to repeal and replace the Affordable Care Act, children and health advocates urged Congress to not forget that the law currently provides coverage for former foster youth. In a letter sent to Congress this week, more than 240 organizations expressed their support to ensure that youth who age out of foster care can keep Medicaid coverage until they turn 26, in parity with their peers who can stay on their parent’s health insurance until the age of 26.

Over 20,000 youth age out of care each year with very few supports or financial assistance. In addition, former foster youth represent some of the most vulnerable youth with high incidence rates of homelessness, incarceration, and chronic and mental health conditions.

The Medicaid to 26 provision of the ACA has allowed former foster youth continuity in their health coverage which improves the well-being and success of these youth as they transition into adulthood.

“Former foster youth are a particularly vulnerable group who have unique health needs. Congress must do no harm and threaten coverage for these young adults,” said Bruce Lesley, President of First Focus. “Many kids rely on support from their parents well into their 20s and former foster youth should be no different in having access to health coverage. We urge Congress to ensure Medicaid coverage for these youth continues as it considers changes to the Affordable Care Act and -- now Medicaid as well.”

Advocates have enormous cause for concern as Republican proposals, including Paul Ryan’s A Better Way: Our Vision for a Confident America, promotes the option of per capita caps or the block granting of Medicaid. Both options would reduce the overall number of youth covered and leave former and current foster kids vulnerable to a loss of coverage, benefits, and access to care. In fact, under Ryan's block grant option, the guarantee to coverage would appear to be eliminated. That would threaten the coverage of both former and current foster kids and youth.

Visit campaignforchildren.org to read the letter to Congress and learn you can take action on behalf of kids.

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The First Focus Campaign for Children is a 501(c)(4) nonprofit organization affiliated with First Focus, a bipartisan children’s advocacy organization. The Campaign for Children advocates directly for legislative change in Congress to ensure children and families are a priority in federal policy and budget decisions.

In a letter sent to Congress this week, more than 240 organizations expressed their support to ensure that youth who age out of foster care can keep Medicaid coverage until they turn 26, in parity with their peers who can stay on their parent’s health insurance until the age of 26.

Over 20,000 youth age out of care each year with very few supports or financial assistance. In addition, former foster youth represent some of the most vulnerable youth with high incidence rates of homelessness, incarceration, and chronic and mental health conditions.

Letter to Congress

View the fact sheet.

The Family and Medical Insurance Leave Act (The FAMILY Act), sponsored by Rep. Rosa DeLauro (D-CT) and Sen. Kirsten Gillibrand (D-NY), will provide family and medical leave for families during crucial childbearing years. This fact sheet details its health and economic benefits to children and families.

FOR IMMEDIATE RELEASE: FEBRUARY 8, 2017

(WASHINGTON, D.C.) – Amid sweeping changes by the incoming Trump Administration, First Focus Campaign for Children has issued its policy recommendations with a clear “do no harm” standard toward policies that impact America’s children during the first 100 days of the new presidency.

These child-focused recommendations come in light of President Donald Trump’s inauguration speech in which he acknowledged the universality of the rights of all children, saying: “And whether a child is born in the urban sprawl of Detroit or the windswept plains of Nebraska, they look up at the same night sky, they fill their heart with the same dreams and they are infused with the breath of life by the same Almighty Creator.”

Top recommendations from First Focus policy experts include:

• Improving the health of children by funding the CHIP program, reducing asthma triggers, and protecting against lead poisoning;
• Applying a “do no harm” standard for any repeal-and-replace measures of the Affordable Care Act;
• Ending child poverty by strengthening family tax credits and setting a national Child Poverty Target;
• Ensuring immigration policies protect child safety and well-being by protecting DACA and providing increased support to unaccompanied minors;
• Reauthorizing the Maternal, Infant, and Early Childcare Home Visiting (MIECHV) program to ensure the best start in life for young children; and
• Focusing on child abuse and neglect response efforts to support children in foster care and end human trafficking.

In a statement First Focus Campaign for Children President and CEO Bruce Lesley said, “The recommendations we are putting forth are bold. We will not shy away from issues that impact every citizen – including the 16 million children that will be born in this country be born over the next four years. Those children deserve to be met with and be assured of a bright future.”

Read the entire list of child policy recommendations at CampaignForChildren.org.

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The First Focus Campaign for Children is a 501(c)(4) nonprofit organization affiliated with First Focus, a bipartisan children’s advocacy organization. The Campaign for Children advocates directly for legislative change in Congress to ensure children and families are a priority in federal policy and budget decisions
First Focus Campaign for Children is a bipartisan nonprofit children’s advocacy organization that advocates directly to ensure that children and families are a priority in federal budget and policy decisions.