Medicaid spending caps in Republican proposal would cut coverage for Florida children

May 18--Low-income children in Florida gained Medicaid coverage under the Affordable Care Act despite the state's refusal to expand eligibility for the public health insurance program, according to a study published Wednesday by the non-partisan Urban Institute, a health policy think tank.

But those gains may end if the American Health Care Act -- the Republican-sponsored bill to repeal and replace the health law known as Obamacare -- creates spending caps for Medicaid, according to the consulting firm Avalere Health in a separate report this week.

A per person spending cap for Medicaid would reduce federal funding for Florida children who receive Medicaid by $2.3 billion from 2020 to 2026, according to an analysis by Avalere Health, a consulting firm.

Though the ACA's coverage provisions primarily focused on uninsured adults, the health law helped increase coverage among low-income children by insuring more of their parents, raising awareness about the mandate to have health insurance, and simplifying enrollment and renewal processes, said Jennifer Haley, an Urban Institute researcher and co-author of the report.

In Florida, as in the rest of the nation, the rate of uninsured children and parents dropped from 2013 to 2015. The ACA's Medicaid expansion provision, which is optional for states, took effect in 2014. During that time, the 31 states that expanded Medicaid eligibility to nearly all low-income adults saw greater gains than the 19 states, including Florida, that did not choose expansion.

In Florida, the rate of uninsured children dropped by nearly four percentage points, from nearly 11 percent in 2013 to about 6.5 percent in 2015, the Urban Institute found. But parents in Florida saw even greater gains, with the uninsured rate dropping by nearly eight percentage points, from nearly 25 percent in 2013 to about 17 per cent in 2015.

Budget Health Care

In this March 2017 photo, House Speaker Paul Ryan of Wisconsin speaks about the American Health Care Act -- the Republican plan to repeal and replace the Affordable Care Act -- during a news conference on Capitol Hill in Washington, DC. The House passed the AHCA in May and the bill is now in the Senate.

J. Scott Applewhite AP

Haley said the change was "dramatically different" from the years prior to the ACA's passage in 2010, when the uninsured rate among low-income parents was rising.

But while the number of Floridians with Medicaid has grown from about 3.7 million in 2013 to 4.3 million in 2017, the use of spending caps as proposed under the AHCA and requested by Florida Gov. Rick Scott would lead to reductions in health benefits and other changes, said Caroline Pearson, a senior vice president for Avalere.

Medicaid spending caps as proposed under the AHCA would eliminate open-ended federal funding, which currently guarantees payment of 61 percent of Florida's program costs.

Caps in federal funding would force Florida to either spend more state money on the program, or more likely, Pearson said, ration healthcare for low-income children and their parents, pregnant women and the disabled -- the only groups currently eligible in Florida.

148,000 Uninsured children in Florida eligible for Medicaid or the Children's Health Insurance Program in 2015

"You do have to kind of pick and choose between multiple vulnerable groups," she said.

Children are an easy target, Pearson said, because they represent the largest group covered by Medicaid, they're generally healthy and their care tends to cost less than adults.

In Florida, children make up about 60 percent of the Medicaid population, according to the state's Agency for Health Care Administration. But they accounted for 27 percent of the estimated $23.3 billion Florida spent on Medicaid in 2016.

"On the one hand, kids are cheap," Pearson said. "But on the other hand, they may be perceived as low need and a place where states think they can save a lot of money without sacrificing a lot in health."

Daniel Chang: 305-376-2012, @dchangmiami

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