Bruce Japsen – CONTRIBUTOR : I write about health care and policies from the president’s hometown. (Opinions expressed by Forbes Contributors are their own)
A partial repeal of the Affordable Care Act could cost up to 13 million children to lose their health coverage if Congress scales back financial support of Medicaid for poor Americans and eligibility for kids’ health benefits falls to new minimum levels.
Under the law signed six years ago by President Obama, millions of Americans gained coverage when the ACA provided states a generous federal funding to expand Medicaid. There are 31 states plus the District of Columbia that adopted Medicaid expansion under the ACA, including states led by Republican governors like Ohio’s John Kasich and New Jersey’s Chris Christie.
But Republicans control the U.S. Senate and House with an ally in the White House in Donald Trump who will allow them to scale back coverage gains, particularly if lawmakers use budgetary maneuvers that allow legislation to pass the Senate with a simple majority. If that is done with the law repealed without an immediate replacement, millions will lose eligibility, according to the Urban Institute’s Health Policy Center.
“We find that 4.4 million children and 7.6 million parents could lose coverage in 2019 if Congress’s budget reconciliation process repeals pieces of the ACA without a replacement plan,” researchers at the Urban Institute wrote in a report released Wednesday called “Partial Repeal of the ACA through Reconciliation: Coverage Implications for Parents and Children.”
“ Under the repeal bill, states would be able to reduce Medicaid and CHIP eligibility for children beginning in 2017 . We find that up to 9 million more children could lose coverage if states lower Medicaid/CHIP eligibility to the new minimum standards.”
Congressional leaders have vowed to repeal the ACA, but haven’t come up with a replacement plan. U.S. House Speaker Paul Ryan told 60 Minutes that Congress would repeal the law next month.
“We will pass a budget and that budget in the beginning of this first session in January will put in place the budget mechanism that we need to repeal Obamacare while we work on an orderly transition to replace it with something much, much better,” Ryan told 60 Minutes’ Scott Pelley earlier this month.
While Ryan and his fellow members of Congress work on their replacement plan, advocates for the uninsured and academics who study healthcare are sounding the alarm about repercussions to those who gained coverage under the ACA.
If a partial repeal is “modeled on the reconciliation bill” Republicans passed earlier this year that was vetoed by Obama in January, the Medicaid expansion would be “struck down,” the Urban Institute report said. Also going away would be tax credits and “cost-sharing assistance” for Americans who purchased subsidized individual coverage on public exchanges. Over the years, Republicans have produced many Obamacare repeal bills and they generally narrow eligibility for health coverage for children.
“In every state, the number of uninsured children in 2019 would be higher under partial repeal than it would be under the ACA,” the Urban Institute report states.
Lobbies for hospitals, doctors and insurance companies have begun lobbying Congress to not pass legislation that would reduce gains in those with coverage. Insurers like Aetna AET +0.22%, Anthem WLP +%, Centene CNC +0.00%, Humana HUM +0.26% and UnitedHealth Group UNH -0.24% have reaped profits and million of new customers from the Medicaid expansion that they largely manage for states across the country.
In California alone, the state would lose more than $20 billion in federal funding if Medicaid expansion is reversed, according to a study out this week from the University of California, Berkeley’s Center for Labor Research and Education. The state’s Medicaid program, known as Medi-Cal, and the ACA’s expansion covered 3.7 million Californians
“California has made tremendous gains since 2014 in reducing inequities in access to health insurance,” Laurel Lucia, co-author of the report, said in a statement. “If Congress repeals the ACA, those historic coverage gains would be reversed.”