Commentary: Bill ending Medicaid guarantees puts children in jeopardy


In 1965, the federal government made a promise to children with disabilities and from low-income families: They would have health coverage. In 2017, the federal government is about to break that promise. The Better Care Reconciliation Act of 2017 jeopardizes children’s access to health care because it no longer guarantees health coverage through the Medicaid program. Instead, the bill caps the federal government’s funding for children’s health care, leaving innocent children, who cannot control what family they are born into or what ailments they are born with, at the mercy of appropriators.

While the bill does take some positive steps toward protecting children, including exempting children with disabilities from per capita caps, those children are still at risk. Once the federal government limits Medicaid funding, states will need to make up the difference or limit the services or the number of Medicaid enrollees to stay under the federal cap. And they are likely to do this through across-the-board cuts, which will affect all Medicaid enrollees, including children with disabilities.

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There are 30 million children in the United States enrolled in Medicaid, more than 40 percent of the nation’s kids and nearly half of all Medicaid beneficiaries. This includes 3 million children in Texas, or almost half of the children in the state. Yet children don’t drive Medicaid costs; children without disabilities make up about 70 percent of the Medicaid caseload in Texas but account for only 30 percent of the spending.

To children’s hospitals in Texas, these are not just statistics. These numbers represent the children and families our member hospitals see in their emergency rooms and hospitals each day. Our hospitals are the pediatric safety net for all Texas children, with services and expertise specifically designed for kids. In fact, in 2014, more than 14,000 patients in children’s hospitals were transfers from other medical facilities that could not provide the necessary pediatric care those children required.

Medicaid provides a safety net for working families that have children with complex medical conditions. The program helps shoulder the financial burden not covered by commercial insurance, ensuring that these families are not devastated financially.

Children with access to Medicaid are more likely to attend school, graduate from high school and go to college, becoming healthier adults who will earn more and pay more in taxes than those who do not have appropriate health care as children. Dramatic changes or across-the-board cuts to Medicaid will hurt coverage for children and decrease their ability to access appropriate and timely health care.

Thanks to the efficiency of the program, growth in per capita Medicaid expenditures in Texas falls below both commercial insurance and Medicare levels. When adjusted for inflation, Texas is spending less per Medicaid enrollee than the state did in 2001.

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Due to the high number of children enrolled in Medicaid, children’s hospitals rely heavily on it to pay for patient services. For the eight member hospitals of the Children’s Hospital Association of Texas, between 50 percent and 80 percent of their admissions are Medicaid patients. And even at current funding levels, the actual cost of care exceeds the amount that Medicaid pays. Many hospitals must absorb the cost for poor children who are not insured or are underinsured.

Children’s hospitals support families from before birth through the end of life, from prenatal care and genetic counseling through palliative and hospice care. Congress should support American families by continuing to guarantee Medicaid coverage for all children and pregnant women. Taking this pro-family approach will fulfill Medicaid’s original purpose of providing health coverage to children with disabilities and from low-income families. Congress should not break its 50-year commitment to ensuring that children have access to health care to get their best start in life.

Wilson is the president of the Children’s Hospital Association of Texas.



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