The American Health Care Act (AHCA) poses a real threat to the wellbeing of children in America. The AHCA’s proposed changes in Federal funding for Medicaid will significantly reduce the monies available for Medicaid. As the largest group covered by Medicaid, children will be the most harmed.
A recent study by Avalere Health calculated that the Federal Medicaid funding changes mandated in the AHCA will reduce funding for “traditional children” by $43 billion from 2020–2026. The study did not include children who were eligible for Medicaid due to disability because of the lack of comprehensive and accurate data on Federal spending for disabled children at the state level. There are 3 million disabled children in the United States that are “medically fragile.” These children are generally dependent on one or more mechanical devices, such as a ventilator, to live. Of these 3 million children, approximately 2 million receive health care paid for by Medicaid. It is estimated that 40 percent of the Medicaid funds spent nationally on children are spent on medically fragile children. It is this population that stands to be harmed the most by the AHCA.
The medically fragile children population is growing at 5 percent per annum, a rate of growth that is 6 percent greater than the annual growth factor established by the AHCA for the per capita cap on Federal Medicaid funding. This disparity between the rate of growth of the population of medically fragile children and the Medicaid funds available for them will have a significant adverse impact on the care provided to these exceptional children.
Paradoxically, reducing Medicaid funds available to medically fragile children will increase the overall cost of care for these children. Today, most medically fragile children receive essential health care from home health care agencies in the comfort of their own homes. With less funds available, home health care agencies will not be able to sustain providing care to these children. That will result in medically fragile children being cared for in institutional setting, which in turn will dramatically increase the cost to provide care to this population.
I cannot imagine that those advocating for reforms to Federal Medicaid funding, such as those mandated by the AHCA, would do so knowing they will adversely affect the type and quality of care received by our nation’s most vulnerable population, medically fragile children. I estimate that 8 percent of all Medicaid dollars (Federal, state, and local) go to the provision of health care to medically fragile children. The Federal portion would be approximately 5 percent.
Medicaid is a political hot button these days. However, Medicaid is multi-faceted and reducing spending on disabled children would be both morally and economically wrong. No matter your political leaning, we should all agree that our great nation must provide for the most vulnerable among us. Those in Congress can design Federal Medicaid reform that excludes any changes to the funding mechanisms in Medicaid that would lead to a decrease in funds available for medically fragile children. It is my great hope that our elected officials will do so.