Children’s Defense Fund
It’s back. The assault on our children’s health coverage has been resurrected for a final last-minute attempt at passage and is even more dangerous and cruel than ever. The latest Graham, R-S.C., and Cassidy, R-La., revision of the health repeal bill would feel like a Halloween movie cliche with a zombie-like villain that refuses to die if its threats to children, seniors and more of America’s most vulnerable weren’t so deadly serious.
It almost defies belief that after repeated failed attempts Republican senators are trying once again not only to take away the benefits to children, families, other adults and seniors included in the Affordable Care Act, which has helped insure nearly 20 million people, but they are reaching beyond the ACA to dismantle Medicaid. Medicaid’s safety net has been in place for 50 years under presidents of both parties and is a lifeline for 37 million children, covering almost half of all births and more than 40 percent of children with special health care needs. It also ensures coverage for low-income adults including those with disabilities and covers two out of three nursing home beds. Over these many months, even the most rabid “repeal and replace” politicians didn’t campaign on getting rid of the ACA and its protections without replacing it, and even President Trump vowed there would be no cuts to Medicaid. But like the earlier “repeal and replace” health bills that failed to pass, this bill repeals the ACA without replacing it, dismantles Medicaid and is even more egregious than its harsh predecessors.
Here are some ways the cruel Graham-Cassidy repeal bill threatens children, parents, other adults and seniors:
It ends Medicaid as we know it with a massive cost shift to states by imposing a per person cap on federal spending, regardless of need or unexpected costs like the opioid epidemic, rising drug prices or recent hurricanes or other natural disasters. States would have to pay all costs in excess of the cap, or more likely – since it would become increasingly impossible for states to fund the gap that grows bigger and bigger over time – make huge cuts in eligibility, benefits and provider payments that will most certainly leave children and other vulnerable populations worse off. Education agencies will be left with many fewer Medicaid dollars to help school systems assist children and youths with disabilities, and child welfare agencies will have to struggle to ensure health care for children and youth in foster care who have the state as parent and children with special needs adopted from foster care.
Replaces the ACA’s marketplace subsidies and Medicaid expansion with a block grant funded well below current levels. These federal funds would end altogether after 2026, resulting in more people losing coverage. States would have broad authority to spend block grant funds on any health care expenses with no requirement that dollars help low- and moderate-income Americans get health coverage.
Allows states broad waiver authority to exclude coverage of essential health benefits including mental health, substance abuse treatment and maternity care. It also allows states to return to the day when insurance companies were allowed to charge higher premiums based on health care status, allowing again discrimination against children and adults with pre-existing conditions.
Destabilizes the individual insurance market in the short run by ending the mandate that all adults purchase coverage and eliminating the ACA’s subsidies to purchase individual coverage. In the long run, such changes are likely to lead to the collapse of the individual insurance market.
Derails bipartisan efforts to extend federal funding before Sept. 30, 2017, for the Children’s Health Insurance Program, which ensures affordable, comprehensive health coverage for 9 million children.
With only days left until Sept. 30, the deadline after which the Senate can no longer try to pass a health care bill with only 50 votes (with Vice President Pence to break a tie), Republican senators are rushing to pass a cruel bill and have spent virtually no time debating how their votes will affect many millions of lives and affect one-sixth of our economy. Without a complete and careful analysis yet from the independent Congressional Budget Office, independent analysts agree this mean bill is a massive funding cut to states and will result in millions of Americans losing health coverage. Independent analyses from Avalere and the Commonwealth Fund, for example, found Graham-Cassidy would lead to $4 trillion in cuts to states over the next two decades from the draconian Medicaid cuts and elimination of the Medicaid expansion and tax credits for the ACA marketplaces that make coverage more affordable.
Who supports these harmful anti-child policies? Given the previous “repeal and replace” bill that failed to pass the Senate was only slightly less draconian and had an approval rating at the time of 12 percent, it might seem implausible Graham-Cassidy could pass. Those voicing strong opposition include medical professionals, disease groups, the American Medical Association, American Hospital Association, American Cancer Society, March of Dimes, AARP, Children’s Hospital Association, the Blue Cross Blue Shield Association, and America’s Health Insurance Plans, a powerful lobby largely silent until now. And despite the misleading hype about the bill giving states the flexibility they want, a growing number of governors – Republicans and Democrats – have come forward to oppose it too along with the National Association of Medicaid Directors. All states would face deep and increasing cuts to federal coverage over time from Graham-Cassidy, and states that have worked the hardest to get people enrolled in health coverage would face the severest cuts and greatest losses. No good deed to help the most vulnerable seems to go unpunished.
In a few weeks, people of all faiths will come together for the National Observance of Children’s Sabbaths Celebration, “Moving Forward With Hope: Love and Justice for Every Child.” It’s a vision I wish every elected leader shared. Some congregations will read this passage from Proverbs: “Speak up for (those unable to speak), for the rights of all the unfortunate. Speak up, judge righteously, champion the poor and needy.” I hope you will make sure senators and all members of Congress hear immediately, loudly and clearly that attacks on Medicaid and health coverage for children and the poor and most vulnerable must stop right now and for good.
And if they do not vote NO on the Graham-Cassidy cruel repeal bill, I hope you will remember when they seek your future support.
Marian Wright Edelman is the president of the Children’s Defense Fund. For more information, go to http://www.childrensdefense.org.