The American Health Care Act threatens health coverage for children. As pediatricians, we work to combat childhood illnesses and promote well-being. Health-insurance coverage ensures that we can provide needed services to the youngest and most vulnerable among us, even in the face of complex social and structural barriers and disparities.
Over the past eight years, health-insurance coverage among American children has improved to 95 percent, and the rate of uninsured children in North Carolina has fallen to 4.4 percent – less than the national average. In North Carolina, 69 percent of all Medicaid and Children’s Health Insurance Program, or CHIP, enrolees are children. The path to fiscal responsibility in this country is not by cutting critical programs for children. Access to affordable, high-quality health coverage is essential for our patients, who are our community’s future leaders.
The cost of health care can be high, and no family should have to choose between the health of their child and their ability to pay for services. Based on Congressional Budget Office estimates of the initial version of the health care bill, $839 billion would be cut from Medicaid over 10 years, which would amount to a $6 billion loss for North Carolina.
The bill rolls back Medicaid expansion and caps federal Medicaid funding, which would shift costs to states and lead to substantial enrollment cuts. This would mean less coverage for children who need it the most: those with special health care needs and those from low-income families. State-based waivers could eliminate existing guaranteed coverage for those with pre-existing conditions and set lifetime benefit limits, no matter what insurance a child has. This would leave millions of people who need care the most in jeopardy. No child chooses to be born premature, develop Type 1 diabetes or be diagnosed with leukemia – all of which could be considered pre-existing conditions.
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Through Medicaid’s Early and Periodic Screening, Diagnostic and Treatment standard, children have access to all medically necessary services, including developmental, vision and hearing screenings. The AHCA would threaten our ability as pediatricians to keep kids fully vaccinated, refer them to early intervention services and ensure that they are not exposed to high levels of lead in their homes and schools.
Evidence shows that access to Medicaid and CHIP as children leads to success as adults. Children enrolled in these programs miss school less often, are more likely to graduate from college, have higher earnings and pay more taxes as adults than their uninsured peers. The allure of short-term savings through cuts to Medicaid obscures the substantial future costs to our society in the form of worse outcomes as children emerge into adulthood.
But this issue isn’t about numbers and acronyms; it is about the children who would be affected. A child with congenital heart disease delays follow-up due to a lapse in insurance coverage and is found to have worsening heart function that could have been prevented. Another child with cancer undergoing treatment that costs $7,000 per week pauses her care due to a gap in coverage. A depressed teen who finally musters the courage to seek help is unable to afford needed treatments. These cases are among many examples of why insurance is so important. If children lose coverage, they delay care, are unable to obtain treatment and ultimately experience poorer health outcomes.
We are pediatricians and hopeful participants in our democracy, trying to do right by the children we care for. We, along with the American Academy of Pediatrics, are nonpartisan and pro-children.
The discussion surrounding the AHCA should not be about who wins and who loses the political battle. Rather, the question should be what we as adults and the current shepherds of our society desire for our children and future generations. Children are the largest group of Medicaid beneficiaries, and there is no way to cut Medicaid without harming them. We urge U.S. senators Richard Burr and Thom Tillis to vote against any legislation that would cut Medicaid funding. We believe in the inherent worth of all children, as they are our most enduring and yet most vulnerable legacy. That legacy is at stake now more than ever.
Ganga Moorthy, MD
Ann Reed, MD, FAAP
Avital Fischer, MD
Debra Best, MD, FAAP
Elizabeth Erickson, MD, FAAP
Govind Krishnan, MD
Richard Chung, MD, FAAP, FSAHM