It is difficult to predict the final federal health care
legislation at this time; however, it may have life and death ramifications as
well as public health consequences. Medicaid is now the largest source of
health care insurance in the United States, covering 34 million children and
40% of the 4 million live births in the US each year. These programs comprise
about 20% of the $545 billion spent for Medicaid in 2015. The Children’s Health
Insurance Program (CHIP) covers an additional 9 million near-poor and
middle-income children at a cost of almost $15 billion. Together with Medicaid,
these two programs cover nearly one-third of all US children.
Thirty-one states have opted into the Medicaid expansion set up
by the Affordable Care Act (ACA) also known as “Obama care”. This legislation
expanded the ability for more children and others to qualify for coverage.
Among other provisions, this groundbreaking legislation mandated coverage by
commercial health insurance companies for essential health benefits including
preventive care (such as immunizations) and for pre-existing medical conditions.
The ACA currently mandates “first dollar” coverage for ACIP recommended
immunizations as well as the attendant physician visits, without any co-pays or
other expenses for the patient or their family. The unfortunate Republican
efforts to “repeal and replace” the ACA would terminate many of the most
important provisions including Medicaid expansion and would cap federal
contributions to states for all Medicaid programs. These and other callous
efforts would lead to a 25% reduction in federal Medicaid spending and up to 22
million individuals loosing their health insurance coverage.
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