Those of us in pediatrics have seen the proposed American Health Care Act. We have examined the Congressional Budget Office scoring. So we have reached an inescapable conclusion: The AHCA potentially puts the health care benefits of 30 million children at risk.
How many of those children actually could be affected? Which benefits in particular could children lose? We don’t know. One of the many problems of the proposal in its current form is how little attention it pays to the specifics of children’s health coverage. It does not protect funds for children. It does not guarantee that children will get medically-necessary care.
[See: How to Pick a Health Insurance Plan.]
This may come as a surprise to people who think of the AHCA simply as a bill that will ” repeal and replace” the Affordable Care Act (or “Obamacare”). The AHCA goes beyond that. It changes how Medicaid is funded, and in turn, likely reduces the access that children will have to medical care they need.
Medicaid is the single largest insurer of children in the country. The program provides health care coverage for children when their families could not otherwise afford it. Children are able to see physicians and visit hospitals when they are sick because of this coverage. A primary focus of pediatric professionals around the country is keeping children well, and Medicaid allows children to get screenings, vaccines and other preventative care that keeps them from needing additional (and often more expensive) doctor and hospital visits.
Medicaid funding now changes when health care expenses change. If certain illnesses become more or less prevalent, or if new treatments become available, funding adjusts. Medical science advances all the time, and the program as currently constructed recognizes that the health care and medical conditions of 2007 are not identical to the health care and medications of 2017.
[See: What Your Doctors Wish You Knew.]
The new AHCA does not allow Medicaid to fluctuate in that way. Instead, it locks in a per capita cap model based on the health care environment of 2016. It limits funding to the states with the cap model, which likely translates into limiting coverage for children.
There is a lot we do not know, because the AHCA is not specific enough to tell us. We can, however, make some surmises:
— Medicaid now provides health coverage to approximately 30 million children, or about 40 percent of all U.S. children.
— The proposed AHCA will cut Medicaid spending by 25 percent by 2026, according to the Congressional Budget Office.
— The AHCA does not specifically protect funding for children, so there is every reason to believe the 25 percent reduction will include a reduction to children’s benefits.
— Because there is no specific protection for children, if adult Medicaid spending runs over its allotment, money intended for children could be diverted to cover the adult gap under the AHCA. That could result in an even larger reduction to child health benefits.
— The changes start in 2020. That means cuts could both “uninsure” children who now have health coverage and affect children who have not been born.
At a minimum, any change to Medicaid must protect funding for children. It must allow children to receive medically necessary treatment. It must not have a detrimental effect on children who are insured now, and who will need to be insured in the future.
Research shows that children covered by Medicaid have better health, educational and economic outcomes as they become adults, compared to children who have no medical insurance. It is reasonable to think that preserving Medicaid coverage for children actually helps achieve the goal of less health care spending in the future.
From the prospective of people involved in children’s health care, this is not a political argument. We have real concerns that our most vulnerable population will be denied access to necessary medical care. Congress must preserve that access through Medicaid.
[See: How to Be a Good Patient Wingman.]
You can let Congress know that you feel the same way. The Children’s Hospital Association has created a feature that lets you send a personalized message to your congressional representatives about the issue. The entire process takes just one minute here.
Medicaid is critical to the health of our children, and all of us should be invested in the future of the program. Add your voice while you can.
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The American Health Care Act: How Proposed Changes Put Millions of Children at Risk originally appeared on usnews.com
