US Senate leaders are rushing to get a health care bill passed. Like the American Health Care Act (AHCA), which was passed by the House of Representatives in May, the Senate's Better Care Reconciliation Act (BCRA) proposal (PDF) poses serious and devastating threats to California's kids and families. In fact, the BCRA would result in an estimated 539,000 California children losing insurance (PDF).
Any Medicaid cuts are bad for kids. Medicaid, or Medi-Cal as it's known in California, covers over half of California's kids and provides comprehensive benefits for children. New research confirms that Medicaid is even more important for the health of rural kids. In California's small towns and rural areas, 54% of children are covered by Medi-Cal, compared to 44% of kids in metro areas.
Compared to children without health insurance, kids with Medi-Cal do better in school, miss fewer school days, are more likely to graduate from high school and college, have fewer emergency room visits and hospitalizations as adults, and earn more money as adults. At the community level, Medicaid is an important source of funding to safety-net providers, community clinics, and hospitals.
The BCRA gets an "F" for protecting Medicaid. The bill would dramatically restructure Medicaid financing (PDF) by capping federal funds going to the program. This essentially shifts huge costs to the states to maintain coverage and care. California's Department of Health Care Services estimates that the BCRA would shift more than $114 billion in costs to California between 2020 and 2027.
School Medi-Cal Services Put at Risk
The BCRA would also shift the costs of providing school-based health services and special education services, which Medicaid now pays for, to school districts and the state. School districts rely on Medicaid to cover the costs for special education services (such as physical therapy) and equipment (like feeding tubes) to serve low-income students and those with disabilities. Without this support, schools will struggle to provide high-quality services them and will have great difficulty complying with federal mandates associated with the Individuals with Disabilities Education Act (IDEA). Medicaid also is an important source of coverage for preventive care, such as vision and hearing screenings and immunizations, for other Medicaid-eligible children. Losing Medicaid-supported services in school will hurt children and disrupt students' learning opportunities.
BCRA supporters misleadingly claim to provide "protection" for some children who are determined to have a disability. The bill proposes to exempt them from the Medicaid per-capita cap. Unfortunately this means very little when the base program providing that coverage is stripped of funding at the scale proposed by the BCRA. And in California, if a Medicaid cap would be bad for the 180,000 "medically complex" children with Medi-Cal, then why would it not also be risky for the other 5.6 million California children who get their health care through Medicaid?
The BCRA would also undermine the private health insurance markets used by California families and businesses to purchase coverage. The bill would repeal the Affordable Care Act's health insurance premium tax credits and cost-sharing reductions and replace them with less generous subsidies to fewer families. This risks destabilizing the Covered California marketplace, which covers 77,000 kids and nearly 1.4 million adults.
Widespread Negative Effects
The BCRA would undermine the ability of families to access health care and the chance for local communities to prosper. Like the AHCA, under the Senate bill we can expect to see millions of Californians lose Medicaid coverage (PDF) and the loss of thousands of public and private sector jobs in California, making job-based health coverage even less available to hard-working families. As we all know, children live in families, and when a parent's or family member's coverage is threatened, the whole family suffers. That's bad for kids.
If health insurance is unavailable or fails to provide real protections to families, then we will be right back in the bad old days when health care was a greater burden on the budgets of California families and half of all bankruptcies were attributable to medical debt. The threats from these federal health care bills are causing more than half of all Californians to worry that they or their family members will lose health coverage.
It is shameful that the BCRA does not have even a single provision that makes kids' lives better, which is why pediatricians immediately declared that the BCRA "fails children." Health care legislation must meet the very low bar of at least doing no harm to kids.
For more on the potential impact of the BCRA, read "Where's the 'Better Care' in Senate Health Bill?," "A Brazen Plan to Dismantle Medicaid," and "Medi-Cal Enrollment of Seniors and People with Disabilities, County by County."