Proposed changes to Medicaid would harm Washington’s children

Sujatha Jagadeesh Branch, Children & Youth Project Directing Attorney

The American Health Care Act (AHCA), currently being debated in Congress, would make sweeping changes to Medicaid. And that’s bad news for Washington’s children.

As it happens, two out of three of participants in Washington’s Medicaid program are children. Indeed, Medicaid is one of Washington’s largest health insurance programs for children, providing coverage to 677,000 children—65% of the program’s participants. Not everybody realizes this. Medicaid has an identity crisis in Washington, where we call Medicaid “Apple Health;” even some people who receive Apple Health don’t realize that what they receive is Medicaid. Sadly, the importance of Medicaid for Washington’s children is often forgotten, especially when debates about public health insurance programs become heated or even mean-spirited.

Coming into existence in 1965 as part of the War on Poverty, Medicaid has, through its fifty-two-year lifetime, been a federal-state program, imposing federal eligibility standards while allowing state flexibility, and requiring participating states and the federal government to share the costs. The proposed Medicaid changes in the AHCA include limiting Medicaid eligibility and changing financing to impose a “per capita” limit, which would have a dire impact on both children and adults. Rather than paying half of the cost of services provided to Washington Medicaid participants as it has for fifty-two years, the federal government would shift responsibility to the state: Washington would receive a certain flat amount of federal funding per Medicaid participant, and any additional costs would be the state’s responsibility.

Over time, the AHCA would require states to expend significantly more funds on Medicaid or to reduce eligibility and services. The Washington governor’s office estimates that 600,000 Washingtonians who gained coverage through recent expansion of Medicaid would lose their coverage. While the Washingtonians who immediately lost their coverage would probably be adults, other changes resulting from AHCA would affect both children and adults: our uninsured rate would almost triple (from 5.8% of the state’s population to 15%), and the state would have to pay a staggering additional $175,000,000 per year to cover lost health care. Financial pressure would therefore make it difficult for the state to keep its Medicaid system intact.

Besides the funding problem, the changes to Medicaid that the AHCA would require would have severe repercussions. From my experience over the years as an attorney who represents children and adults in Medicaid cases, I can see at least three:

  1. Many low-income parents have jobs that don’t provide health insurance, making Medicaid their only source of coverage. Reducing Medicaid would reduce pregnant women’s access to prenatal care, and children’s access to medical care.
  2. Parents of children with disabilities can find it quite difficult to find jobs outside the home that are consistent with their caregiving responsibilities. Reducing Medicaid would make it difficult for them to take care of their children and increase the risk of inappropriate, costly institutionalization.
  3. Medicaid interrelates with other programs that serve children, such as public schools and foster care. Reducing Medicaid would have a ripple effect, putting pressure on these other programs and compromising their ability to help children.  

So the AHCA’s proposed changes to Medicaid would cause lasting harm to a program with a fifty-two-year track record of success, and to the hundreds of thousands of Washington’s children who rely on it for health insurance. And if you need any further inspiration to defend Medicaid, I recommend watching this Youtube video from New Mexico, called, “Medicaid Rocks!”