BUILDing Strong Foundations

Three Reasons to Maintain the Affordable Care Act

10/3/2017 12:00:00 AM
Posted by: Build Initiative

By Mariana Florit, Director of Communications at BUILD Initiative 

While the immediate threat of an Affordable Care Act (ACA) repeal has passed, it’s safe to assume that it’s only a matter of time before the GOP attempts another effort to reduce health care coverage. As the administration endeavors to cut corners and limit access to equitable healthcare, our nation’s poorest children and families are at risk of losing health care coverage. The most recent GOP ACA-replacement, the Graham-Cassidy bill, would have jeopardized coverage for the nine million children protected by the Children's Health Insurance Program (CHIP), which has not received renewed funding despite a September 30 deadline for Congress to take action on the policy.

BUILD Initiative Position on Equitable Access to Health Care

From birth to age five, children require significant preventive and developmental health services. Children also require early identification of and response to health-threatening conditions. Just as important is attention to social, emotional, behavioral, and physical development, and practices that fuel healthy development. A strong health system for young children must address children’s biological, medical, and physical concerns. It must also serve as a first responder to the many social factors and determinants contributing to a child’s healthy development. This includes linking young children and their families to the rest of the early childhood system.

The BUILD Initiative focuses its health equity efforts on raising awareness and expanding understanding of the social determinants of health, and their connection to disparities in health and early learning outcomes of young children and their families. These efforts are defined by our goal to build comprehensive, high-quality early childhood systems that promote equitable outcomes. In addition, our work in this area underscores the urgency and proactive timing in the first five years of life.

While We Were Talking About the ACA

With the media spotlight on the ACA, some may not have noticed that Congress has allowed funding for CHIP to expire. By December of 2017, through March of 2018, states will begin to deplete their CHIP funds. The effects will trickle down from families and into schools, with many children in the program no longer able to attend well-child visits or receive immunizations, oral and vision care, care when sick, etc. Our collective efforts to increase access to health care need to address BOTH ACA and CHIP funding.

This May 2017 Urban Institute report points out that although the ACA did not change eligibility for children as much as for parents and other nonelderly adults, the law transitioned some children from CHIP to Medicaid in 21 states; extended CHIP authorization through 2019 and federal CHIP funding through 2015; raised the federal CHIP matching rate; and, under “maintenance-of-effort” provisions, directed states to maintain children’s eligibility standards at the levels in place when the ACA was enacted in 2010 . Federal funding for CHIP was subsequently extended by the Medicare Access and CHIP Reauthorization Act of 2015, which authorized CHIP funding through fiscal year 2017.

Maintaining the ACA Matters

While we recognize the limitations of the Affordable Care Act, we can not throw the baby out with the bath water. Here are our top three reasons to maintain the Affordable Care Act:

  1. More people - including children - are insured than ever before. Roughly 2.8 million children, birth to 18, gained coverage under ACA and subsequent policy changes. These changes, implemented between 2010 and 2015, reached more children and families than prior expansions targeting low-income children.
  2. Important progress has been made to reduce inequities in health. The ACA has increased access to health insurance coverage among people of color, who are disproportionately at risk of being uninsured. The uninsured rate has dropped by 47 percent for non-elderly Blacks and by 35 percent  for non-elderly Hispanics since 2010.
  3. Children are more likely to have insurance if their parents have insurance, and are more likely to be uninsured if their parents are uninsured. According to a Government Accountability Office (GAO) analysis, 84 percent of children had the same insurance status as their parents, and 16 percent did not. Within that GAO analysis, a child was eight times more likely to have public insurance if their parent had public insurance, when compared to a child whose parent was uninsured.

How does all of this play out in real life?

Noted education leader Pedro Noguera, underscoring the critical impact of health on education, once said that the Obama Administration’s greatest contribution to education was health care reform. In addition to the  connection between attendance and education success - a well used example of why access to health care and health equity are critical - young children’s oral health represents one of the major causes of absenteeism from early learning and then school.

Early learning and education do not exist in isolation. As systems leaders, we know that equitable access to healthcare - as part of an early learning system - is critical to success for every child.


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