Op-Ed: Congress' Health Care Reform Fails New York's Children

On May 5, 2017, Crain's New York Business published an op-ed by Suzanne Brundage, program director of the Children's Health Initiative and Patricia S. Levinson Fellow, about the potentially devastating consequences of the proposed American Health Care Act for New York's children. The text of the op-ed appears below.

Congress' health care reform fails New York's children

The revived American Health Care Act puts our youngest in danger

By Suzanne Brundage

In 1997, 12% of children in New York state were uninsured. Today it is 2.5%. Only Vermont, Massachusetts, the District of Columbia and Hawaii have lower rates of uninsured children. No state has made better use of near-universal coverage than New York to push for improvements in care for children, laying the groundwork for lifelong health and well-being.

This impressive accomplishment is now at risk. The revised American Health Care Act, passed by the House of Representatives Thursday, retains provisions that would reduce federal spending on Medicaid by $839 billion, according to earlier Congressional Budget Office estimates. Such a drastic cut—effectively one-fourth of the program—along with the act's radical restructuring of how Medicaid financing is provided to states, will have deep and far-reaching human consequences. Far too little attention has been paid to the fact that more than 40% of Medicaid participants are children, or that 40% of America's children are covered through Medicaid or the Children's Health Insurance Program (CHIP, which will need Congressional reauthorization this year), including 2.5 million children in New York age 21 and under.

It took decades of groundbreaking legislative, executive, and judicial actions to get this close to universal health coverage for children in New York. In 1990 the state established its Child Health Plus program, the model for the national CHIP, allowing low-income families that earned too much for Medicaid eligibility to purchase health insurance for their children. Buoyed by the Affordable Care Act, New York also helped low-income parents purchase insurance—recognizing children of healthier parents had a better shot at being healthy.

We haven't reached perfection—approximately 104,000 New York children still lack health coverage. But getting near 100% coverage has led to real and significant benefits. Families with sick kids are less likely to put off care because of cost or to face financial ruin when they do seek care. National research shows that children insured under Medicaid are more likely than uninsured children to graduate from high school and from college, to become healthier adults, and to attain economic success. And not to be underestimated, as compassionate citizens we can have high confidence that a child who becomes ill will receive the care that is necessary—reflecting an important societal value that we protect the most vulnerable among us.

Thursday's AHCA vote is particularly painful because New York continues to strive to do more for its children. It is restructuring health payments to emphasize value of pediatric care over volume, and beefing up mental health services for children throughout the state. It is enlisting primary care doctors to screen children and their families for the social and economic needs that are a critical component of good health, and then steering them to the appropriate services to meet those needs.

The future of Medicaid, and therefore the future of children's health insurance, is now in the U.S. Senate's hands. New York has long led the nation on children's health coverage, with other states following its example. Now Sens. Charles Schumer and Kirsten Gillibrand will need to carry that legacy into their chamber's debate. A failure to maintain high quality, comprehensive Medicaid coverage would not just fail New York kids. It would fail all kids.