Speaker: Kids primary recipients of Medicaid – The Daily Advance

For more than 20 years, the United States and North Carolina have been marching toward universal health coverage for children.

Efforts to reform health care shouldn’t halt that momentum, said NC Child policy analyst Sarah Vidrine at a meeting of the League of Women Voters Thursday night. The meeting was held at Christ Episcopal Church in Elizabeth City.

Considering a Congressional bill to “repeal and replace” the Affordable Care Act and to cut Medicaid failed less than a week ago, the discussion is also timely.

“That discussion has not centered around children at all,” Vidrine said of lawmakers’ debate about the ACA.

Vidrine said the ACA and Medicaid fit into a “crazy quilt” of federal programs that ensure kids get coverage even if their parents can’t afford private coverage. Medicaid, coupled with the Children’s Health Insurance Program (CHIP for short, and known as NC Health Choice in North Carolina), are why 95 percent of kids in the United States have coverage. She noted that North Carolina’s coverage rate is slightly higher at 96 percent.

For all the talk about adults on Medicaid, she said “the primary recipients of Medicaid are kids, nationally and in North Carolina.” Kids are also cheaper to insure than other Medicaid beneficiaries, she noted. According to Kaiser Family Foundation research she shared, in 2011, children and their parents made up about 74 percent of Medicaid enrollees, but only 38 percent of expenses.

Congress also supplemented Medicaid by creating CHIP in 1997, providing coverage to families who couldn’t afford private insurance but whose incomes were still too high to receive Medicaid, she said.

With Medicaid and CHIP, she said North Carolina’s rate of uninsured children has gone from 16 percent in 1996 to 4 percent now.

The ACA intertwines with both federal and private health insurance for kids, she explained. It requires public and private insurance plans to cover 10 “essential health benefits,” such as maternity and newborn care, pediatric care including dental and vision, and numerous preventative services. It also requires private insurers cover people with preexisting conditions – which she said includes more than half a million children in North Carolina.

What would have changed if the repeal-and-replace bill, the “American Health Care Act,” had become law? Vidrine noted the Congressional Budget Office projected the bill would, in addition to causing millions of Americans to lose health insurance, would have cut $880 billion from Medicaid through 2026. She noted the bill would have capped Medicaid expenses, rather than commit to pay for as many children as are eligible.

“Caps are cuts,” Vidrine said, noting the bill would’ve passed costs down to states or to the public. She argued that would mean the federal government is “abdicating its responsibility” to care for impoverished and some times very sick children.

“It could revert us to this pre-1965 system, which is why folks came together to enact Medicaid, because the health of our communities was struggling,” she said.

Given Medicaid expenses are open-ended now, fiscally conservative lawmakers argue it needs to be capped to encourage more cost-effective services and avoid eating up money for other vital services. North Carolina had to spend about $4.56 billion on Medicaid in 2015, according to the Kaiser Family Foundation, with the federal government contributing $8.9 billion.

Vidrine argued Medicaid, while an open-ended expense, is still cost-effective. She said the program’s costs are growing slower than those of private insurance. As to Medicaid’s outcomes, she pointed to a study from the National Bureau of Economic Research that found that expanding Medicaid eligibility during the 1980s contributed to high school graduation rates and college completion rates for kids born in that decade. Educational attainment generally correlates with better economic and health outcomes.

Running somewhat contrary to that study, however, is an often-cited 2013 study out of Oregon that found a trial group of adult Medicaid enrollees didn’t see significant improvements in health over a two-year period; those results are also described through NBER. Asked about the study, Vidrine suggested its time frame was too short to expect participants’ health to change much.

Going forward, it’s unclear what lawmakers will try next in health care reform, Vidrine said. Whatever happens, Vidrine said called for preserving children’s access to comprehensive health insurance.

Also speaking briefly Thursday were Jan King Robinson, a former vice president of what’s now Sentara Albemarle Medical Center, and retired pediatrician Nita Coleman. Robinson called for Americans to put children’s needs first in health care reform.

“When we do that, our coalitions come together seamlessly, the politics falls away,” she said.

Coleman also urged Americans to regularly phone their elected officials about their views on health care. It may not seem to do much good, but constituent feedback adds up over time to sway lawmakers, she said.


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