In the middle of the night, in an effort to save their flawed health care bill, Republicans released a number of amendments to the American Health Care Act (AHCA) that would dramatically impact the ability of low-income children, including millions of children with disabilities, to access health care. AHCA’s original language changed Medicaid financing to a per capita cap financing scheme that would harm children and families and burden state budgets. The bill would also eliminate coverage for certain low-income school aged children and deny them access to important preventive services including vision, hearing and dental. The amendments House Republicans released last night add insult to injury by offering states the option of a block grant (an option that includes a financial incentive for states) and permitting states to impose a work requirement that could apply to some parents – even those with young children.
Medicaid is a multi-generational program set up to protect our most vulnerable consumers at any stage in their lives including infants, toddlers and school-aged children. Roughly half of the 73 million enrolled in Medicaid around the country are kids and almost 60 percent of children with disabilities rely on Medicaid for coverage and access to necessary health services. Under the current Medicaid program, children have special protections to make sure they have access to the health care they need. These protections include no cost-sharing and access to a comprehensive benefit package known as Early Periodic Screening, Diagnosis and Treatment (EPSDT), which provides the full range of services children need to help them develop and grow.
The original language in AHCA would roll back eligibility for children ages six to 18 from 133 percent of the Federal Poverty Level (FPL) to 100 percent of FPL. The amendments would exacerbate this eligibility rollback by allowing states to implement a block grant. A block grant, like the one House Republicans are proposing, would significantly decrease the amount of funding available to states and would not keep pace with increases in medical spending or eligibility needs. Because of this massive cut in federal funding, states would be forced to cut benefits, roll back eligibility, increase cost sharing, and deny children comprehensive preventive care they need to stay healthy. This bill gives states permission to make such changes, reversing the Medicaid program’s longstanding commitment to protecting low-income children. Children with special health care needs will be at particular risk for benefit cuts and cost sharing increases. Their more complex health care needs make them a target as states look for places to make cuts and find savings in the new capped funding environment.
These changes would have significant negative long-term impacts on kids health outcomes. Studies show that children who have access to continuous health services lead healthier, more productive lives over the long term. For example, EPSDT helps very young children (0-3 years) access screenings and treatment they need during these critical years for brain development. The House Republican proposal does not require states that choose a block grant to cover EPSDT, putting access to these critical services at risk.
The combination of the eligibility rollback and state’s ability to reduce benefits will also negatively impact school-aged children. Children of color will disproportionately be hurt. For black children whoare six times more likely to attend a high-poverty school than their white peers, Medicaid is a lifeline that can help students access eligible health services inside school walls. These services include, but are not limited to, mental health services, substance use disorder screening and chronic care management (such as diabetes and asthma care). For children with disabilities, the risk, too, is great. Many school-aged children with disabilities require health services in school in order to participate and thrive.
AHCA was already a huge step backwards for children's health and these amendments do nothing to increase access to health care or improve the health of children. In fact, they will only lead to further coverage losses and reverse the progress made since the passage of the Affordable Care Act. They are merely political ploys to try and win over the votes of members of Congress who are on the fence about passing this deeply flawed bill that would strip coverage from millions of Americans.