The American Health Care Act, President Donald Trump’s best hope of repealing and replacing Obamacare, will soon be up for a vote on the floor of the United States Senate. Republican senators first revealed the precise contours of their proposal on Thursday and are now preparing to fast-track the bill so that it requires only a senate majority to become law. Democrats are likely to unanimously reject the bill while most Republicans support it. Currently, 10 Republicans control the potential swing votes.
This morning, representatives from Boston Children’s Hospital raised concerns about how the bill could affect coverage for sick children during a conference hosted on Facebook Live. Amy Judge-DeLong and Joshua Greenberg, both of whom run federal government relations for Boston Children’s, discussed how the repeal could slash Medicaid, harm children with pre-existing conditions, and make lifesaving drugs unaffordable for families.
The conference centered around the three biggest healthcare concerns for kids—Medicaid, comprehensive coverage, and the latitude that states have to change the rules. Cuts to Medicaid could be disastrous for pediatric medicine, because forty percent of American kids are covered by the program. “Anything that hurts that, hurts them,”Greenberg explained. Even if kids maintain coverage, Greenberg cautions, the loss of comprehensive coverage, which makes expensive prescription drugs for hard-to-treat conditions affordable, could be children at real risk of not being able to afford treatment. Even if federal law protects both Medicaid and a child’s right to affordable medications, any bill that gives too much power to the states could be overturned at the local level. States have varied track records on these sorts of decisions.
Judge-DeLong (who had not yet seen the senate bill at the time of the conference) stressed that the very similar House bill that passed in May failed to protect children on all three counts. “Any bill we’re presented with, we can simply look at the scorecard and see if it meets children’s needs,” she says. “The House bill certainly did not…It wouldn’t protect kids in the way we know they need to be protected.”
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Still, not all physicians agree that cuts to Medicaid would harm children. Dr. Jane Orient, managing editor of the Journal of American Physicians and Surgeons, which has earned a reputation for promoting far-right policies, writes that Medicaid eats up nearly 20 percent of state budgets and is wholly inefficient. Those concerns may be warranted. One Government Accountability Office report revealed that 10 percent of Medicaid’s 2016 budget went toward “improper payments,” which is a nice way of saying waste, fraud, and abuse. She also notes that studies suggest Medicaid enrollees have no potentially worse outcomes.
Pacific Research Institute CEO Sally Pipes argues that proposed cuts to Medicaid would likely reduce spending by 1.6 percent or less. “This 1.6 percent cut is what progressives are calling the ‘radical’ and ‘reckless’ reform that could ‘doom’ Medicaid insurers,” she told Forbes. “Come on.”
But Medicaid isn’t the only concern for sick kids. Children with pre-existing conditions, such as spina bifida and congenital heart disease, could have problems under the new bill when they mature and still need advanced healthcare.
“All of the legislative proposals we’ve heard of, to date, suggest they’re going to be particularly aggressive in trimming back coverage expansion for adults,” Greenberg says. The “they” in question is Republican policy makers.
Under the new plan, children with mental health problems could suffer, too. “I can tell you what coverage looked like before [Obamacare],” Greenberg added. “Half of the plans in the US did not have coverage for mental health and substance use disorders. If states are allowed to get out of those requirements, one might, I think, expect there would be much less coverage for mental health and substance use issues.”
If states are given similar latitude when it comes to other aspects of healthcare, travelling out-of-state to fancy hospitals like Boston Children’s for superior care could become a thing of the past.
Whatever your position on healthcare reform, the best way to make sure your voice is heard is to call your senator—especially if you live in a state with one of the 10 “undecided” congressmen. “We’ve listed 10 senators who haven’t said how they’ll vote, and are presumably open to hearing from their constituents about their concerns,” Judge-DeLong says. “Now is the time to reach out.”