By Joan Benso and Denise Salerno
For many years, our state and federal leaders have made a big investment in keeping kids healthy by increasing their access to health care coverage. It’s a little-known fact that some of the greatest beneficiaries of the Affordable Care Act (ACA) are children.
With the health care debate gaining momentum in Washington and some members of Congress and President Donald Trump vowing to repeal the ACA, Pennsylvania’s congressional delegation needs to understand the needs of children – the most vulnerable citizens among us – and what is at stake if a high-quality replacement plan is not immediately available.
The ACA has improved the quality of life for Pennsylvania families in many ways. It protects children with pre-existing medical conditions. It prohibits insurers from establishing lifetime limits on coverage or limiting or denying children’s coverage.
Before implementation of the ACA, children could have been denied coverage or charged a high price if they needed individual market coverage. An end to the ACA means we could return to this poor practice.
The Affordable Care Act allows young adults to remain on a parent’s health insurance plan until age 26, and it enables youth who “age out” of the foster care system at 18 to receive coverage through Medicaid until age 26.
An estimated 89,000 young adults in Pennsylvania could lose health care if they could not continue to be on their parents’ coverage.
Families cannot be charged co-pays for preventive medical services such as immunizations, hearing tests and many behavioral health assessments used to identify issues including autism or depression.
Without the ACA this provision could go away.
The ACA also streamlined the Children’s Health Insurance Program (CHIP) and Medicaid eligibility determination and renewal processes.
Now, verifying eligibility for programs like CHIP or Medicaid can happen immediately or overnight and renewals can happen automatically, which has connected more children with coverage.
The ACA also gave states the opportunity to expand coverage through Medicaid. Pennsylvania joined more than 30 other states in doing so and provided more than 131,000 Pennsylvania parents the opportunity to enroll in coverage for themselves as they enrolled their eligible children. As a result, Pennsylvania’s rate of uninsured kids declined to four percent – the lowest rate in years.
More than 40 percent of Pennsylvania children are covered through CHIP and Medicaid. As discussions continue on a possible ACA replacement, it’s important to note that CHIP and Medicaid are funded through a state-federal partnership, with the federal government picking up the majority of the costs for both programs.
Changes such as federal funding caps or a block grant may pit kids against the disabled, seniors or even their parents. We cannot afford to go backward and the state doesn’t have the resources to fill the gap.
Health insurance status is the single most important factor impacting children’s access to health care, and providing coverage to children improves that access.
Children who have insurance are more likely to be immunized, receive regular check-ups and get prompt treatment for common childhood ailments, such as ear infections and asthma.
Uninsured children are less likely to see a doctor on a regular basis and when symptoms develop. Overall, an uninsured child is more likely to be hospitalized for a preventable problem than an insured child.
In addition to the direct health benefits of insurance coverage, when children have access to quality physical and behavioral health care that meets their needs, they have better school attendance and academic performance and working parents are less likely to need unexpected time off due to child illnesses, benefitting employers.
Pennsylvania’s children need reliable, high-quality health care coverage. In the coming weeks and months our congressional delegation will likely consider several possible reforms to our federal health care system that will affect them into their adult lives.
All we ask is that policymakers do the right thing and keep the needs of children at the forefront during discussions, so that affordable, high-quality coverage is preserved – never diminished.
Joan Benso is president and CEO of Pennsylvania Partnerships for Children in Harrisburg. Denise Salerno is president of the Pennsylvania state chapter of the American Academy of Pediatrics.