The cruelest of April Fool’s Day jokes is coming. According to a recent report, up to 6.7 million children may lose health insurance through Medicaid on April 1, which brings the end of pandemic protections that kept them insured.
Kicking so many kids off Medicaid will be disastrous. It will mean children with asthma don’t get medications and wind up in emergency rooms. It will translate to fewer children vaccinated and result in lower numbers of children with mental health conditions able to get care. As a neonatal intensive care specialist, I know that these losses will render the premature babies I care for unable to see specialists for their ongoing lung, heart, neurologic and nutrition challenges.
Medicaid is the foundation of our children’s health insurance system, now providing coverage to 57% of the nation’s kids. In Florida, 66% of children are covered by the program. National COVID-19 legislation required states to keep children in the program as a condition of federal financial support — preventing states from removing health coverage for the duration of the COVID emergency.
This pause on canceling children’s coverage has been remarkable. Since 2020, 20 million children gained Medicaid coverage. The number of uninsured children dropped by 1.5 million to the lowest rate ever recorded. As doctors, we saw more children coming to clinics for checkups, immunizations and hearing and vision screening. During the recent “tripledemic” of influenza, COVID and respiratory syncytial virus, fewer ill children came to the hospital uninsured. My newborn patients require uniquely made, concentrated, liquid medications that can only be obtained from specialized pharmacies, and it was refreshing to see new parents able to afford these complex prescriptions.
These protections will disappear at the end of the month, threatening to undo the gains over the past three years. And it’s not just that some kids will no longer qualify. Because of bureaucratic hurdles, more than 70% of these children may lose coverage even though they remain eligible. States now face the herculean task of verifying if over 40 million kids remain Medicaid eligible, and several are eager to save budget dollars by canceling children’s coverage as families fail to grapple with the red tape and bureaucracy required to prove they still qualify. In Florida, 1.1 million children could lose health insurance.
Even children not covered by Medicaid are at risk. Congress is also considering repealing financial assistance to families who purchase insurance on the exchanges created as part of the 2010 Affordable Care Act. At that time, the government provided tax credits so middle-income families would not pay more than 4% of their total salaries in premiums.
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COVID relief measures fully covered the cost of modest insurance plans for these families, and increased the levels of support to those who earn higher incomes, ultimately lowering the cost of health insurance for 29 million people. Removing these benefits means the cost of health insurance could swell, which will yield more uninsured families.
There’s a simple way out of this mess.
Cover all Medicaid-eligible children through early childhood, removing the governmental hurdles families must navigate to keep kids insured. In December, Congress mandated all children in Medicaid be covered for their first year of life. Extending that to kindergarten age eliminates the red tape and state cost of figuring out if children qualify for the program. Most importantly, it prevents doctors from having to prescribe treatments based on whether they’re insured and takes advantage of the progress we’ve made throughout the pandemic.
Oregon now covers all children in Medicaid through age 6, and New York is considering the same measure. Streamlining health insurance through early childhood provides coverage through the ages we administer most childhood immunizations, autism screening and nutrition screening — making kids as healthy as possible entering grade school. As states wrestle with the burden of contacting tens of millions families, they should openly ask if Oregon hasn’t figured out a better and easier way.
Children suffered many setbacks during the pandemic. Thankfully, losing health insurance wasn’t one of them. As we emerge from the pandemic, state governments shouldn’t give children and families a new problem to deal with.
Shetal Shah is chairperson of the national Pediatric Policy Council, a practicing neonatologist and executive member of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine.