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We Need to Talk About Medicaid

Adequate access to health care ensures children are able to get the help they need when they get sick or injured, allowing them to learn and grow into healthy and productive adults. In Nebraska, Medicaid provides access to health care for nearly one in three children. The American Health Care Act (AHCA) puts access to health care for Nebraska’s children at grave risk.

Last week, the House of Representatives passed the American Health Care Act on the slimmest of margins: 217-213. Much of the debate before and after the vote has focused largely on pre-existing conditions and the costs of premiums, not on the bill’s nearly $1 trillion in proposed cuts to Medicaid. This is unfortunate because these cuts to Medicaid will end the program as we know it, and are likely to have the largest impact on children. Nationally, children make up nearly 2/3 of all Medicaid recipients, yet comprise only 1/3 of all costs to the program.

Since its creation nearly 50 years ago, Medicaid has been a state-federal partnership where the federal government pays a set percent of the costs each year. AHCA represents a fundamental shift in the program to a per capita or per person payment structure that will be increasingly inadequate as time goes on in covering the cost of health care for children, people with disabilities, and the elderly who rely on Medicaid for their health care. Under the bill, states will also have the option to eliminate EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) coverage for children that currently help ensure babies receive vaccinations at their well-child visits and children with significant medical needs get the care and treatment they need. The AHCA also eliminates the Medicaid in Schools (MIPS) program which will result in fewer preventative health services in our schools, layoffs of school health personnel and/or higher local property taxes to make up for the loss in revenue. Currently, school districts are able to receive Medicaid reimbursement for students, including those students with special needs, and are able to provide their students with the speech therapists, school counselors, and occupational therapists they need to be successful in school.

These changes are estimated to eliminate nearly $1 trillion in federal Medicaid spending to the states, nearly 1/4 of the current Medicaid spending by the federal government. States like Nebraska that are already facing budget shortfalls (nearly $1 billion in the next two years) will not be able to make up the loss in federal funding and will be forced to impose waiting lists, enrollment caps, eliminating or rationing services, decreased payments to Medicaid providers, or some combination thereof. Nebraska’s rate of uninsured children has declined in recent years, a positive change that keeps children healthy and safe. If the AHCA becomes law, however, we will likely see an unconscionable return to high uninsured rates among children.

There is still time to prevent this crisis from happening. The United States Senate has begun discussion on the AHCA and will be voting on the bill soon.

Contact Senator Deb Fischer and Senator Ben Sasse today and tell them to stop cuts to Medicaid and preserve Nebraska children’s access to health care!

Senator Deb Fischer (202) 224-6551

Senator Ben Sasse (202) 224-4224


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