As the largest program in the federal “safety net” of public assistance programs, Medicaid provides essential medical and medically related services to the most vulnerable populations in society. Not only has Medicaid been a lifesaver for tens of millions of older Americans for 50 years, it has helped Americans of all ages, including millions of children. Together with the Children’s Health Insurance Program (CHIP), it has brought the number of uninsured children to a historic low. Medicaid and CHIP provide comprehensive and affordable health coverage to more than 44 million children — 57 percent of all children in America. And with the new coverage options offered by the Affordable Care Act (ACA), 93 percent of all children now have health coverage. Yet, at a time when we should be celebrating Medicaid and CHIP successes, serious threats to Medicaid, CHIP and the ACA continue to surface in Congress.
The 2016 Budget Resolution, passed by the Republican-led House and Senate, paves the way to radically restructure Medicaid, making deep cuts that will reverse the progress made in reducing the rate of uninsured children, pushing tens of millions of Americans — including millions of children — into the ranks of the uninsured and underinsured. The GOP’s budget agreement also puts in motion a process to repeal the ACA and undo all of its benefits — like prohibiting discrimination against the 129 million children and adults with pre-existing health conditions, extending coverage to over 5 million previously-uninsured 18-26 year olds through parental insurance plans, and expanding Medicaid coverage to age 26 for some youths leaving foster care.
If the repeal process plays out, more than 10 million near-poor adults, including many parents, in the twenty-nine states and the District of Columbia that have implemented the ACA’s Medicaid expansion will lose Medicaid coverage as a result (and let’s not forget about the millions who have already been left uninsured in the 21 states where Republican leadership has rejected the Medicaid expansion). In total, the GOP’s plan to repeal health reform’s coverage expansions would eliminate coverage for the estimated 16.4 million people who have newly obtained it and prevent millions more uninsured from gaining it in the future. Ultimately, repeal would leave 25 million more uninsured Americans than under current law, including many working parents and families, the Congressional Budget Office estimates.
While children comprise 48 percent of those enrolled in Medicaid, they account for less than a quarter of Medicaid costs. Medicaid’s current structure guarantees children the health and mental health care to meet their individual needs when they need it and must be protected. The GOP budget includes major structural changes like block grants and per capita caps, which would limit expenditures for the entire Medicaid program and eliminate the long-standing guarantee of health coverage for children. These cuts don’t create cost efficiencies; instead, they shift costs from the federal government to states, local communities and/or beneficiaries. “The federal government and the states now share in any unanticipated costs; under the budget agreement, states alone would bear them,” explains Edwin Park, Vice President for Health Policy at the Center on Budget and Policy Priorities (CBPP).
Over time, federal funding would fall farther and farther behind states’ needs. To deal with the shortfall, states would have to increase their spending, make deep cuts or both. Any supposed “savings” from this budget plan would come from reducing eligibility, limiting benefits, increasing cost sharing, or cutting already below-market provider payment rates — any one of which would inflict harm on millions of vulnerable children and families. Ultimately, these funding shortages threaten to “reverse the 40 percent reduction in the uninsured rate for children seen since the late 1990s, bringing us back to a time when millions more children lacked access to health coverage,” the Children’s Defense Fund warns. Changes that result in loss of or limits on children’s health coverage would also require states and local communities to absorb substantial costs: an uninsured child costs the local community $2,100 more than a child covered by Medicaid.
Right now, Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit guarantees the full range of comprehensive primary and preventive coverage children need, preventing more serious and costly consequences later on. Almost 75 percent of children enrolled in Medicaid had a preventive well-child visit in the past year compared to 41 percent of uninsured children. Children enrolled in Medicaid miss fewer classes and perform better in school than uninsured children, leading to lower dropout rates and better long-term economic opportunities. Medicaid also covers more than 40 percent of all births in the United States, and research indicates that every $1 spent on prenatal care can save $3.33 in costs associated with care immediately after birth, plus another $4.63 associated with costs later in the child’s life. Medicaid also provides an essential lifeline for children with disabilities, serving 40 percent of children in America with special health care needs.
Recent research documents the long-term benefits of Medicaid coverage in childhood. The National Bureau of Economic Research compared children eligible for Medicaid during childhood to their non-eligible peers and found that the Medicaid-eligible children were more likely to attend college, make greater contributions as adult taxpayers and live longer than those without coverage. The findings reaffirm the economic case for doing what common sense and morality already dictate: by investing in childhood well-being now, the government will recoup the benefits later. After 50 years of Medicaid’s protections, how can any elected leaders still not get it, or get it, but simply not care about the most vulnerable among us?