Over the past three decades, the United States has made marked progress in reducing the rate of uninsured children. Today, 95 percent of children under age 6 have health insurance, and many receive coverage through public programs such as Medicaid; the Children’s Health Insurance Program, or CHIP; and the Affordable Care Act, or ACA. The ACA improved access to affordable insurance plans through the marketplace; expanded Medicaid; and extended funding for CHIP, which covers millions of low-income children.
But legislation under consideration in Congress would undo this progress, taking the country backward and threatening health care services for millions of children. Republicans in Congress, led by House Speaker Paul Ryan (R-WI), plan to repeal the ACA and replace it with the American Health Care Act, or AHCA. In its current form, the AHCA would roll back children’s insurance coverage by capping federal funds for Medicaid, ending Medicaid expansion, and restructuring the health care marketplace.
Here are three ways in which the AHCA would affect young children.
1. Children would lose access to preventive health services
The AHCA includes cuts to Medicaid that could affect many children’s access to preventive health care services. Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment, or EPSDT, benefit guarantees coverage for preventive health services for children, including screenings, diagnostic evaluations, and early intervention. The AHCA’s changes to Medicaid, which would reduce federal funding for the program, could remove the guarantee of the EPSDT benefit. Under budgetary pressures, states are likely to reduce the services available through their Medicaid programs, meaning that millions of children would potentially lose access to critical preventive care.
2. Families would likely pay more for health insurance
The AHCA proposes fundamental changes to the structure of the current health care marketplace, which would shift the financial burden of children’s health care to their parents. One analysis found that costs for families would increase by an average of $6,148 by 2020. The cost increase is even greater for lower-income and middle-class families: A typical family with an income below $60,000 would pay an average of $10,926 more for health care in 2020.
Increased costs would mean that some families could not afford health care services. When costs are high, researchers find that financially strapped parents are more likely to delay or forgo medical services, dental care, and prescription medication for their children. Delaying care may prove even more costly—both financially and in terms of children’s health—if a given condition worsens and becomes more difficult to treat.
3. Children would lose access to Medicaid
If enacted, the AHCA would limit children’s access to Medicaid by reducing federal spending on Medicaid, which would put pressure on states to limit eligibility, reduce benefits, or raise cost sharing. One recent analysis found that more than 3.6 million children under age 18 would lose access to Medicaid by 2026. Parents that received Medicaid under the ACA expansion may lose their health insurance, which has an indirect impact on children. Research consistently demonstrates a strong connection between parental and child insurance rates, especially among Medicaid-eligible children. Low-income families with uninsured parents are three times more likely to have eligible but uninsured children compared with families with parents covered by private insurance or Medicaid. In fact, only 32 percent of children who have neither parent insured are insured themselves, compared with 98 percent of children who have both parents insured.
The AHCA poses a direct threat to young children, especially those in low-income and middle-class families who would be most harmed by increased costs and reduced access to health care services. Even more problematic is the fact that reductions in services to young children appear to offset tax cuts for wealthier families. Providing preventive care and health insurance to young children—and avoiding the long-term costs of untreated health conditions and preventable diseases—should be a common-sense goal of any health care plan.
Jessica Troe is the Policy and Outreach Coordinator for the Early Childhood Policy team at the Center for American Progress. Rebecca Ullrich is a Policy Analyst for the Early Childhood Policy team.