A year ago President Obama signed into law the Patient Protection and Affordable Care Act (the “Affordable Care Act”), guaranteeing access to health coverage for 32 million uninsured people in America including 95 percent of all children. Racial minorities are disproportionately uninsured today and the Affordable Care Act will have a particularly positive impact in communities of color if allowed to go forward.
The first pieces of the Affordable Care Act to take effect have brought critical relief to millions of children and young adults. As implementation of the law proceeds insurers can no longer deny coverage to children with pre-existing conditions, impose annual or lifetime caps on coverage, or revoke coverage when someone gets sick. Insurers must cover preventive services for children without co-payments or cost sharing. Parents can keep children on their insurance until age 26 helping more than 1.2 million young adults as they graduate from school and work. The hundreds of stories in a new book by Moms Rising about how health reform has improved the lives of children and families reflect the many failures that have been fixed. We must continue to move forward.
Yet even as we celebrate health reform, the Affordable Care Act and one of its cornerstones, the Medicaid Program, are under attack. Medicaid is a health lifeline for millions of children and vulnerable people. Opponents of the Affordable Care Act have promised to repeal, roll back, or defund the law and have targeted Medicaid for “reform” that would actually cripple the program and the lives of the children and low income people who depend on it.
Medicaid currently covers close to 60 million people, including many children with disabilities or special health care needs, pregnant women, low income adults, and seniors. Under the Affordable Care Act in 2014 Medicaid will expand to reach 16 million more children, parents, and childless adults with incomes below 133 percent of poverty ($29,400 for a family of four). Medicaid and the Children’s Health Insurance Program (CHIP) together provide health coverage for more than one in three children and more than four in 10 births.
In February, the House of Representatives passed a bill that prohibits funding for implementation of the Affordable Care Act. Next week the House is expected to take up legislation that would allow states to cap spending for Medicaid decimating all current guarantees of coverage. In a further assault on children’s health care, the House is expected to consider legislation to repeal the maintenance of effort provision which prohibits states from cutting back on Medicaid and CHIP coverage for children until 2019.
Failing to invest in children’s health through the Medicaid program will put our nation on exactly the wrong economic track. Research has shown that an uninsured child costs the local community $2,100 more than coverage for a child with Medicaid or CHIP. Sacrificing the health and achievement of the next generation is penny-wise and pound foolish when other nations are pulling ahead and leaving our children behind.
Medicaid has served as an important safety net for hundreds of millions of children in the almost 50 years since it was enacted and played a critical role in keeping children covered during the recent recession. Children constitute more than 50 percent of total Medicaid beneficiaries but only about 20 percent of the program’s cost. The program is efficient, with administrative costs about half that of private insurers, and lower per child costs.
The low cost of covering children compared to the high costs of dealing with the consequences later is a no brainer: efforts to cut children’s coverage by capping federal Medicaid spending, repealing the maintenance of effort provision, or defunding the Affordable Care Act are all shortsighted and would be harmful to our nation’s future economic security. Strengthening our nation financially need not and must not come at the expense of our most vulnerable children’s health; strengthening our nation requires investing in children.