Americans spend more on healthcare than residents of any other developed nation and the United States healthcare system remains one of the lowest performing health care systems in a high-GDP country. There are over 3.6 million uninsured children in the United States and 25 million uninsured adults. Although the number of uninsured has decreased in the wake of the Affordable Care Act, which the Trump administration has undermined by limiting outreach to get people covered and limiting funding of government programs that help people understand their coverage options. There remains a long way to go before Americans and, more specifically, American children have access to the services they need to stay healthy. And this is not merely an insurance issue. It’s a quality of care issue that has emerged as a result of economics.
In November, voters will have a chance to vote on a wide variety of ballot measures and for or against candidates with specific healthcare agendas. Affordable and accessible health care has ranked as the top issues for midterm voters across the country, regardless of party. People are paying attention. Parents should be paying even more attention. Beyond the obvious — that children with healthcare coverage have better access to doctors and can affordably get in front of one — better health care coverage also translates into better school performance and higher graduation rates, which could help the economy at large.
Here how voters can help make a push to improve children’s healthcare in the United States:
How Are Most Kids Insured?
Over 3.6 million kids in the United States don’t have health insurance. So how are most kids who are insured receiving coverage? It breaks down like this: According to 2016 estimates from the Henry J. Kaiser Family Foundation, which follows health care issues across the country, about 38 million — or 49 percent — of American kids are covered through their parent’s employer’s insurance. Another six percent of kids are covered by “non-group” insurance, which is insurance that is purchased by individuals or families and kids are covered as dependents. Those are private options that aren’t sponsored by employers. Some 38 percent, or around 30 million of kids are covered by Medicaid (which includes CHIP); two percent by other public services like VA insurance and insurance from non-elderly Medicare enrollees, and around five percent of American kids are uninsured — roughly over 3.6 million.
What this means is that children’s access to healthcare is largely dependent on children’s parents retaining their jobs. The ongoing assault on Medicaid and the politicization of the CHIP program, which had previously received bipartisan support, by the Republican Party means that this quasi-hostage crisis could get even more problematic for parents concerned about their children’s access to doctors (read: parents).
What’s At Stake in the Midterms?
CHIP’s coverage ran out of funding in several states earlier this year after a government shutdown and the deadline for re-authorizing the pivotal program that insures over 9 million American kids passed. After a few months of uncertainty, the bill was refunded for another six years, meaning that CHIP will be secured until 2024. That’s good news.
CHIP is currently not at risk for either being de-funded or running out of money. Kids are insured. CHIP is a Medicaid program. Medicaid is the single largest healthcare provider in the United States and its expansion through the Affordable Care Act will help get even more kids and families covered over the next several years. Although costs of Medicaid might increase as enrollment should double over the next few years, one issue with Medicaid is that states are attempting to limit the amount of healthcare services that people can get while ensured with Medicaid. That’s a problem.
Medicare, which also insures kids under the age of 22 who have an illness or disability that makes them eligible, will remain solvent through 2026, and after that point, payroll taxes and other revenue from will still pay off over 90 percent of Medicare’s costs. In fact, 85 percent of Medicare will still be covered through 2092, with states picking up the rest of the slack. Medicare is not going to go away. However based on some Trump administration actions, the program could get more expensive.
The 2017 tax law reduced income taxes on Social Security benefits. Some of those go to Medicare funding. And by repealing the individual mandate requiring people to get health insurance, more people will be uninsured, further burdening significantly driving up the cost of healthcare as hospitals struggle to subsidize uninsured patients. Medicare is not going to implode as a system. However, it needs to be prioritized to ensure long-term survival of the program itself and the patients who are insured by it.
In many states, progressive politicians rare unabashedly supporting increasing Medicare funding, expanding Medicaid access and options in their states through the Affordable Care Act, stabilizing the individual market, and some politicians, particularly those in very blue states, are supporting Medicare-for-All and Single Payer healthcare. The advantage of this approach? In the long term, the program would save money, and could eliminate spending waste. People and businesses would save money as well by eliminating copays, deductibles, and bills incurred from emergencies. The problem? The way that Medicare is structured today would likely not be able to sustain a Medicare-for All or single payer program; Medicare covers acute care, not things like long-term hospital stays or routine doctor’s visits. Changing Medicare would take a lot of work and money — but it could be invaluable if done correctly.
There are also a few midterm ballot initiatives which, regardless of House or Senate races, could expand Medicaid coverage in the state through ACA, and potentially get more kids on insurance rolls across the country.
States With Midterm Ballot Initiatives That Could Expand (or Extend) Medicaid
Idaho: Proposition 2: Medicaid Expansion Initiative
Voters can expand Medicaid coverage to more individuals in their state through Prop 2. Through the Affordable Care Act, the law provided that individuals who earn incomes up to 138 percent of the poverty level (a single income of 16,573 or 34,638 for a family of four could be eligible for Medicaid in the state.) This would expand eligibility to people under 65 years old, which could help cover parents and their dependents, whose income is 133 percent of the federal poverty level or below, and who are not eligible for other state insurance coverage.
Nebraska: Initiative 427: Medicaid Expansion Initiative
Nebraska voters can adopt the Medicaid Expansion, made legal through the ACA, which provided that individuals who earn incomes up to 138 percent of the poverty level (a single income of 16,573 or 34,638 for a family of four could be eligible for Medicaid in the state.) This would expand eligibility to people under 65 years old, which could help cover parents and their dependents, whose income is 133 percent of the federal poverty level or below, and who are not eligible for other state insurance coverage. This would get more people insured, making insurance in general less expensive, and would get more kids on coverage rolls. That’s a win for everyone! That could be a win for you!
Utah: Proposition 3: Medicaid Expansion Initiative
Utah voters can vote to expand Medicaid to cover individuals who earn incomes up to 138 percent of the poverty level (a single income of 16,573 or 34,638 for a family of four could be eligible for Medicaid in the state.) This particular proposition would expand eligibility to people under 65 years old, which could help cover parents and their dependents, whose income is 133 percent of the federal poverty level or below, and who are not eligible for other state insurance coverage. This initiative also provides for a sales tax increase from 4.70 to 4.85 to finance the state’s portion of contributions they must make to cover the costs of expansion.
Montana: Montana I-85, Extend Medicaid Expansion and Increase Tobacco Taxes Initiative
Montana already expanded Medicaid eligibility; this ballot initiative allows voters to choose whether or not they want to extend that expansion to fund the program past its current expiry date (June 30, 2019). The funding would come through increasing taxes on tobacco products like e-cigarettes and vapes and cigarettes in general. The tax would increase by two dollars per pack.
What Do Your Gubernatorial and Senate and House Candidates Think?
As of this writing, 34 states (and DC) have adopted the ACA’s Medicaid Expansion, which expanded eligibility to people under age 65. Three states are voting to expand Medicaid in their state, one is voting to expand that expansion, and 12 other states are mulling modifications.
In some states like Florida and Texas, where medicaid expansion is not on the ballot, candidates for senate and for governor have nonetheless focused on healthcare. Statements on the subject are not hard to find. Coverage is the talking point to end all talking points.
The Cost of Care
Democrats tend to support increased federal funding for healthcare and the mandate the insurers cover people with pre-existing conditions — albeit with some caveats. Democrats in solidly blue states, including Senator Kristen Gillibrand of New York, tend to support Medicare-for-All, whereas Democrats in red states, including Beto O’Rourke of Texas, shy away from the issue while offering vocal support for programs that increase insurance enrollment. Republicans tend to push for various shades of a “free market” solution, but many are wary of mounting a full out assault on the Affordable Care Act because the political consequences should premiums skyrocket and care become harder to come by would be profound. Opprobrium over the “socialization” of medicine remains common despite the fact that it is a norm in most of the developed world, one that has done a great deal to alleviate the suffering of children.