Keep kids off the negotiating table in Medicaid reform

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While all eyes are on the alleged scandals swirling around the White House, behind-the-scenes efforts to dismantle the healthcare safety net for children are persisting unabated.

Discussions around repealing the Affordable Care Act are now taking place in the Senate, and Medicaid will once again be in the spotlight. That could spell trouble for the nation’s children.

There will be new ideas, extended discussions and ultimately negotiations that try to improve our healthcare system. But while we applaud discourse and debate, and encourage our elected officials to weigh the pros and cons of all proposals, we have a simple request — as you debate Medicaid, protect children.

{mosads} Right now, Medicaid provides health insurance to more than 35 million children in the United States — almost half the total number of children in the country. And while children represent nearly 50 percent of all Medicaid-eligible beneficiaries, they are currently allocated only 21 percent of Medicaid spending. 


Keeping current levels of Medicaid coverage and access to health services for children is essential and cannot be a negotiating point.

Speaker Paul Ryan (R-Wis.) told the National Review in March that he has been “dreaming” of capping federal funding for low-income Americans since he was a young man. The bill he and President Trump are currently pushing would potentially cut a staggering $880 billion from Medicaid over the next decade. This proposal comes despite a 2015 study by National Bureau of Economic Research that clearly shows children who received Medicaid benefits have longer life expectancy and higher education levels.

If we all agree that education is the gateway out of poverty, Medicaid seems like a sound investment. The same study found that the government recoups much of its investment in Medicaid for children in the form of higher future tax payments. Medicaid, it seems, is also a revenue generator. 

All the data reinforce that it is poverty — above all else — that undermines the health of disadvantaged children. Poor children experience accelerated health disparities, including higher incidence of acute and chronic health conditions, worse outcomes and higher mortality rates. They have greater difficulty accessing services than children who do not live in poverty.  

In our view, and in the view of the medical professionals we work with, the proposed restructuring of Medicaid would pose extraordinary risks to the health and wellbeing of our nation’s vulnerable children by either capping the number of poor children who could receive health services — under a block grant — or by placing a financial limit on how sick a child can be — like establishing per-capita caps. 

We applaud the bipartisan group of House lawmakers who bravely voted against the American Health Care Act despite significant pressure from the White House and congressional leadership. Given the AHCA’s overwhelming unpopularity — a Morning Consult/Politico survey last week found only 38 percent in favor of the bill and 44 percent against it — we can only hope that there will be the same bipartisan bravery in the Senate. Changes to Medicaid have the potential to strip millions of vulnerable children of the essential health care services they need to live happy, productive lives.

Any negotiations on amending the ACA, any budget deals that seek to improve our healthcare system, indeed the art of any future deal, must hold children harmless.

Let’s agree to take kids off the table when it comes to ObamaCare, TrumpCare, or RyanCare. Let’s agree to preserve and protect healthcare for our children; let’s agree to only improve and increase that care — never to diminish it. Right now there are fewer children without health coverage than at any time in our nation’s history. We have made great strides and we should stand firm not to negotiate that progress away. 

Our future depends on it. 


Irwin Redlener, M.D. (@IrwinRedlenerMD), is president and co-founder of Children’s Health Fund and professor of pediatrics and health policy and management at Columbia University. Dennis Walto, M.A. (@denniswalto1), is the executive director of Children’s Health Fund, a nonprofit organization that provides health care to America’s most vulnerable children. 

The views of contributors are their own and are not the views of The Hill.

Tags children's health Healthcare Irwin Redlener Medicaid Paul Ryan

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