Voices Responds to American Health Care Act Proposal

March 10, 2017

This week, leadership in the House of Representatives released their proposal to repeal major portions of the Affordable Care Act. Designated the American Health Care Act, the bill, as currently written, unfortunately represents a major step backwards for children’s healthcare coverage.


One of the most important things children need is good health and appropriate care and coverage that keep them healthy. Ohio has recently hit a milestone in this area: for the first time, more than 95 percent of our kids now enjoy some kind of health insurance coverage. The state’s rate of uninsured children has fallen to 4.4 percent, down from 5.3 percent, and just under the national average. The uninsured rate for our nation’s 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 (CHIP) two decades ago.


Now is not the time to reverse this progress. And, this is exactly what Voices for Ohio’s Children fears will happen with the implementation of the American Health Care Act. One of our primary concerns is the future of Medicaid coverage under the bill’s proposed per capita cap on the program. Medicaid currently provides coverage to an estimated 35 million low-income children across the country and more than 1.2 million kids here in Ohio, where they represent 42 percent of all Ohio Medicaid and CHIP enrollees.


The purpose of a per capita cap is to cut federal Medicaid spending by “capping” the amount each state receives based on the number and type of enrollees. Under this system, states are forced to either finance any shortfall themselves or implement various forms of rationing, such as making cuts in coverage, benefits, and payment rates to providers; shifting more costs to low-income families; or limiting access to care. While states would receive more for child enrollees and those with disabilities, 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, would be most at-risk for rationed care by the federal imposition of a per capita cap on states.


The House bill would also roll back the expansion of Medicaid, which has provided coverage to more than 10 million childless adults in 31 states. Research, and now history, suggests that adults who have insurance are more likely to have insured children. So, at Voices, we were particularly excited to see Medicaid expansion maintained in Governor Kasich’s budget proposal. Coverage has also helped 50 percent of Ohio expansion enrollees secure and maintain employment, nearly 60 percent cover groceries, and 48 percent pay their monthly rent or mortgage. For enrollees who become parents, the coverage provided by Medicaid expansion is transforming the homes their children are born into.


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, Voices is concerned that such changes may leave children with special health care needs particularly vulnerable. Currently, 29, 000 Ohio children are enrolled in Marketplace plans. 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 health insurance coverage for anyone, but especially for children. We urge Congress to return to the drawing board, schedule congressional hearings to discuss and receive 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. Ohio’s children deserve at least that much.


Click Here to Read a Summary of the Legislation


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