The Washington Post

Bi­par­ti­san con­cern for chil­dren’s health

- BY JULIET EILPERIN juliet.eilperin@wash­ Kelsey Snell con­trib­uted to this re­port.

Lower-in­come chil­dren would have their fed­eral health ben­e­fits cut sharply un­der Pres­i­dent Trump’s pro­posed bud­get, which an­a­lysts say could re­verse gains that have pushed unin­sured rates for this vul­ner­a­ble pop­u­la­tion be­low 5 per­cent.

The shift stems from a com­bi­na­tion of fac­tors, in­clud­ing a plan to re­duce Med­i­caid by $1.4 tril­lion over the next decade and a roughly 20 per­cent de­crease in fund­ing for the Chil­dren’s Health In­surance Pro­gram (CHIP), along with pro­posed changes to eli­gi­bil­ity re­quire­ments and the way fed­eral match­ing funds are cal­cu­lated.

Med­i­caid pro­vided health ben­e­fits for 37.1 mil­lion chil­dren over the course of fis­cal 2016, ac­cord­ing to fed­eral of­fi­cials, while CHIP cov­ered 8.9 mil­lion dur­ing that same pe­riod. Of­fice of Man­age­ment and Bud­get Di­rec­tor Mick Mul­vaney said Tues­day that the ad­min­is­tra­tion was act­ing re­spon­si­bly by curb­ing the growth of Med­i­caid. He did not ad­dress fund­ing for CHIP, which cov­ers chil­dren of the work­ing poor.

“There are no Med­i­caid cuts in the terms of what or­di­nary hu­man be­ings would re­fer to as a cut,” Mul­vaney said. “We are not spend­ing less money one year than we spent be­fore.”

Sev­eral Repub­li­cans, in­clud­ing Se­nate Fi­nance Com­mit­tee Chair­man Or­rin G. Hatch (Utah) and House Ap­pro­pri­a­tions Com­mit­tee Chair­man Harold Rogers (Ky.), quickly joined Democrats, med­i­cal ex­perts and chil­dren’s ad­vo­cates in push­ing back. The over­all bud­get, they said, would re­duce cov­er­age for chil­dren in fam­i­lies who make too much to qual­ify for Med­i­caid but not enough to af­ford com­pre­hen­sive health plans.

Hatch, who co-authored the CHIP-pro­gram leg­is­la­tion in 1997, said law­mak­ers were de­ter­mined to pre­serve health in­surance for such chil­dren. “Ev­ery­body wants to help chil­dren,” he said. “We all be­lieve in that. I think that’s a nat­u­ral bi­par­ti­san ap­proach.”

Trump’s plan would cut CHIP spend­ing by $5.8 bil­lion be­tween now and 2019, largely by elim­i­nat­ing the ad­di­tional 23 per­cent fed­eral match the Af­ford­able Care Act gives states be­yond their tra­di­tional Med­i­caid match. The gov­ern­ment would also stop fund­ing the pro­gram for chil­dren whose fam­i­lies earn above 250 per­cent of the fed­eral poverty line — $61,500 for a fam­ily of four — af­fect­ing res­i­dents in 24 states and the District of Columbia.

In ad­di­tion, states would be al­lowed to put more than 562,000 older chil­dren who were moved to their fam­ily’s Med­i­caid plans un­der the ACA back in sep­a­rate state CHIP pro­grams. Some states are likely to charge th­ese chil­dren mod­est pre­mi­ums, which could lead to a loss in cov­er­age.

Joan Alker, ex­ec­u­tive di­rec­tor of Ge­orge­town Univer­sity’s Cen­ter for Chil­dren and Fam­i­lies, said Tues­day that Trump’s pro­posed bud­get “rep­re­sents a very, very se­ri­ous threat in the progress this coun­try has made in cov­er­ing chil­dren.”

“There’s no ques­tion we would make a U-turn on that progress,” Alker said. “It’s just a ques­tion on how sharp a U-turn would be.”

In some in­stances, a de­cline in fed­eral match­ing funds could trig­ger an au­to­matic stop in a state’s CHIP pro­gram. The num­ber of chil­dren with cov­er­age un­der Ari­zona’s CHIP pro­gram, called Kid­sCare, dropped from about 45,000 to less than 1,000 af­ter the state sus­pended it in 2010. More than 8 per­cent of Ari­zona’s chil­dren were unin­sured in 2015, com­pared with 4.8 per­cent na­tion­wide.

Ari­zona restarted Kid­sCare in Septem­ber, and it now cov­ers roughly 20,000 chil­dren there. But if its fed­eral match drops un­der 100 per­cent, Ari­zona law re­quires state of­fi­cials to freeze pro­gram en­roll­ment.

“The com­bi­na­tion of the CHIP and Med­i­caid cuts will be dev­as­tat­ing,” Dana Wolfe Naimark, pres­i­dent and chief ex­ec­u­tive of the Chil­dren’s Ac­tion Al­liance, said Tues­day.

Heidi Capri­otti, spokes­woman for Ari­zona’s Med­i­caid agency, said in an email that state of­fi­cials do not have a po­si­tion on

Trump’s pro­posed bud­get “rep­re­sents a very, very se­ri­ous threat in the progress this coun­try has made in cov­er­ing chil­dren. . . . It’s just a ques­tion on how sharp a U-turn would be.” Joan Alker, ex­ec­u­tive di­rec­tor of Ge­orge­town Univer­sity’s Cen­ter for Chil­dren and Fam­i­lies

Trump’s pol­icy pro­pos­als “and we will im­ple­ment any changes ac­cord­ingly.”

In D.C., where CHIP cov­ers chil­dren in fam­i­lies earn­ing up to 324 per­cent of the poverty level, the bud­get cuts also would trans­late into a loss of cov­er­age.

Ryan Buch­holz, a pe­di­a­tri­cian at Unity Health Care who also serves as its med­i­cal di­rec­tor for qual­ity im­prove­ment, said in an in­ter­view that more than 18,000 of the prac­tice’s pe­di­atric pa­tients re­ceive Med­i­caid cov­er­age.

The loss of cov­er­age would prob­a­bly mean some chil­dren no longer com­ing for an­nual check­ups — vis­its dur­ing which he has of­ten di­ag­nosed se­ri­ous med­i­cal prob­lems, Buch­holz said. Six years ago, he saw a new­born who was vom­it­ing re­peat­edly and re­al­ized that a nar­row­ing in the baby’s stom­ach was prevent­ing his mother’s milk from reach­ing his in­tes­tine. The child, who was cov­ered by Med­i­caid, had surgery and re­mains healthy.

“Los­ing Med­i­caid, in his case, might have com­pletely changed his life,” Buch­holz said. “What does it say that we’re cut­ting off pre­ven­tive care to kids?”

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