Why the AHCA would have been bad for children — and an unavoidable truth moving forward

Claire McCarthy, MD

Senior Faculty Editor, Harvard Health Publishing

Follow me on Twitter @drClaire

Last week the Republicans’ proposed replacement for the Affordable Care Act, or Obamacare, failed to get the support it needed and was taken off the table.

This is good news for children.

Despite all the problems with health insurance generally and the ACA specifically, things are going pretty well for children when it comes to health insurance. According to the American Academy of Pediatrics, currently 95% of children in the United States have health insurance, thanks to Medicaid, the Children’s Health Insurance Program (CHIP), and the ACA.

The proposed replacement, called the American Health Care Act or AHCA, would have cut those numbers, especially the number covered by Medicaid. Currently about 40% of US children are covered by Medicaid, and have access to services (called Early Periodic Screening, Diagnosis, and Treatment, or EPSDT) specifically designed to get and keep them healthy from birth to adulthood. The proposed changes would have made fewer children eligible and would likely have led to fewer covered services, as states made difficult decisions as to what to do with less Medicaid funding. And with lower subsidies for the poor, many families with children simply may not have been able to afford insurance.

Everyone is better off with health insurance, even healthy people — one car accident or fall down the stairs could lead to huge, possibly devastating, health care bills. But children (and women pregnant with those children) need it more than most.

Frederick Douglass said, “It is easier to build strong children than to repair broken men.” This is true in so many ways, but particularly true when it comes to health care. Building strong — and healthy — children is relatively simple. They need good nutrition, plenty of exercise, enough sleep, and access to doctors and medication. They need to be monitored for signs of illness or other problems, most of which are very manageable when caught early. Having a pediatrician and going to regular checkups help make all this happen — and at those checkups doctors can check in with families about other non-medical aspects of building strong and healthy children, such as nurturing, education, and family resources and functioning.

This doesn’t happen without health insurance.

As I said, everyone is better off with health insurance. But when it comes to children, it’s a necessity. Because when something is missed — like a high lead level, an allergy to peanuts, a metabolic or genetic disease, anemia, a smoldering infection, autism — the effects can be lifelong, or even deadly. The effects of small things can become cumulative and irreversible, not to mention extremely costly, both in terms of future health care needs and lost productivity for our economy.

That is why the AAP opposed the AHCA: because it could have led to fewer children with health insurance. And as we move forward as a country to find better ways to provide health insurance to our citizens, one unavoidable truth needs to be very clear: we need to be sure that our children have the coverage and the care they need to grow into healthy adults.

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