Advocates warn rolling back Medicaid could hurt children and people with disabilities

March 17--Tweet

Nearly seven years since the Affordable Care Act was signed into law, nearly 98 percent of New York children have health coverage -- the state's highest ever rate.

The Children's Defense Fund New York released a report this week, outlining the impact of a Medicaid rollback, a feature of the current Republican repeal and replace plan -- the American Health Care Act.

"Make no mistake: these changes would be devastating for thousands of New York State children," Jeorge Cymon, spokesman for the Children's Defense Fund, wrote in an email. "Two million children statewide are now at risk of losing coverage or benefits once the ACA is repealed. The Children's Defense Fund New York compiled data of children insured by Medicaid and (Child Health Plus) who will most likely be affected by the repeal... in the North Country there are 35,733 children insured through Medicaid and 6,685 insured through CHP."

As it stands, the AHCA would freeze Medicaid enrollment and effectively undo the expansion by 2020. The ACA expanded Medicaid benefits, eligibility and funding starting in 2010.

Children are more likely to become enrolled in health insurance and get regular care if their parents are also eligible for coverage.

According to the state Department of Health, 53.8 percent of all New York children, or approximately 2.4 million minors were covered by Medicaid (46.9 percent) or Child Health Plus (6.9 percent.) CHP is the state's insurance plan for low-income children.

Medicaid and CHP account for almost half of all coverage of north country children.

The Children's Defense Fund believes the AHCA could be damaging to families and children on a large scale. According to the nonprofit advocacy organization, the bill could threaten coverage and benefits for children under both Medicaid and CHP by constraining the state budget and costing low-income families more. They say it could also drive families out of employer-sponsored and marketplace plans by cutting tax credits, subsidies and cost-sharing reductions for those who need it the most.

Children make up 38 percent of Medicaid/CHP enrollees in New York.

Several substantial changes were also made to private insurance coverage requirements under the ACA. Young adults can now stay on their parents' health plan until the age of 26. Children, including those with asthma, cancer and disabilities, can't be excluded from coverage due to pre-existing conditions, and insurers can no longer impose annual or lifetime benefit limits.

It's yet unclear how the AHCA would provide the funding needed to maintain these benefits.

According to the Georgetown University Center for Children and Families and the American Academy of Pediatrics, children covered by Medicaid see long-term benefits including missing fewer school days, doing better in classes and being more likely to graduate high school and attend college. These children also grow up to be healthier adults, earn more money and pay more taxes.

Every $1 spent on prenatal care saves approximately $8 in associated costs in a child's lifetime. In 2015, children received an estimated $3,389 in Medicaid spending per enrollee according to Georgetown, compared to an all-ages average of $7,492.

Increased Medicaid funding has also increased the level of care available to children and adults with disabilities.

The Consumer Directed Personal Assistance Association serves and supports individuals with disabilities. Executive Director Bryan O'Malley said the Medicaid expansion has proven vital to allowing people with disabilities to not just live in the community, but to thrive.

"Most people with disabilities receive the bulk of their health coverage through Medicaid, as private insurance just does not cover the services that are needed to keep someone with disabilities independent and in the community.... People with disabilities account for a low percentage of the Medicaid population. However, their needs are such that they account for a high degree of spending," Mr. O'Malley said.

According to Kaiser Family Foundation, about 750,000 people in New York, some 12 percent of the state's Medicaid population, have a disability. Mr. O'Malley said the AHCA could have devastating consequences on people with disabilities.

"As the State seeks to deal with what they have identified as a potential $4.5 billion cost shift from the Federal government to the state, people with disabilities are where they will go to make up that funding, because that is where the potential savings are," Mr. O'Malley said. "For a population that relies on Medicaid for basics such as getting out of bed, higher eligibility levels mean the ability to live a higher quality of life. Low eligibility results in forced impoverishment for people with disabilities."

Organizations like the Children's Defense Fund and CDPAANYS worry about the spending caps that would be created by the bill's block grants.

Capped funding leaves states financially vulnerable to increased costs incurred by epidemic and advances in life-saving health technologies. The opioid epidemic increases the need for medical and mental health services. The estimated cost of treating a child born with microencephaly following a Zika outbreak is more than $10 million in a lifetime.

Under black grant funding, states would have to weigh the needs of different groups and demographics against each other, including the young, elderly and disabled, to distribute limited funding.

"Forcing people into poverty is not a Republican or Democratic ideal. It is un-American," Mr. O'Malley said.

GLANCEBOX:

Children covered by Medicaid or Child Health Plus

Oswego: 14,656 or 50.5 percent

Jefferson: 11,426 or 36.6 percent

Lewis: 3,152 or 47.3 percent

St. Lawrence: 11,449 or 43.8 percent

Statewide: 2,432,246 or 53.8 percent

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