The Affordable Care Act (ACA, or ObamaCare) significantly expanded Medicaid, ensuring that over 95% of children nationwide were covered by health insurance.  Pediatricians celebrated this occasion because it ensured that children would have easy access to their primary care providers, subspecialists, and therapists without forcing families to choose between medical care, food, and shelter. Unfortunately, this great achievement has not been celebrated by President Trump or Republicans in Congress, as evidenced by the American Health Care Act (AHCA, or TrumpCare) passed by the House of Representatives, the budget proposal submitted by President Trump’s administration, and the Better Care Reconciliation Act (BCRA).

The American Academy of Pediatrics (AAP) strongly opposed the AHCA and the BCRA.  Two of the most significant concerns voiced by the AAP regarding both bills is the harm to individuals with pre-existing conditions and the significant decrease in Medicaid spending that would lead to millions of Americans losing their health insurance. These concerns, unfortunately, were ignored.

Members of the AAP were vocal in opposing the AHCA, with significant concerns about how this would harm children and families. Despite AAP activity at the federal level we saw that this administration is declining to recognize the importance of children’s health insurance with the release of President Trump’s requested budget.  In this budget, we see large cuts to Medicaid and Children’s Health Insurance Program (CHIP), and the Supplemental Nutrition Assistance Program (SNAP) in addition to cuts suggested by the AHCA/BCRA.  In the year 2016, over 500,000 children used Medicaid or BadgerCare Plus (Wisconsin’s version of CHIP). Decreasing federal assistance and leaving Wisconsin to make up the remaining funds will force the state to decrease the amount of individuals able to receive Medicaid or BadgerCare, significantly increasing the uninsured and underinsured population.

As a neonatology fellow who takes care of many babies who require these insurances, I’m incredibly concerned about the possibility of families being uninsured or underinsured and trying to make ends meet.  Many of the infants who are discharged home from the NICU have follow-ups not only with their pediatrician, but other specialists and therapists. They have medications and follow-up imaging studies that all cost significant amounts of money.  This would harm the family unit if not covered by insurance.  

While there will be many changes to the budget prior to approval from both the House and the Senate, we need to remain vocal and require that our government put children first. With the many different controversies surrounding President Trump’s administration, it is important to continue to tell your Senators to oppose the Better Care Reconciliation Act.  We should also tell our elected representatives to support a federal budget that does not harm children and low-income families.

Featured image by Martin Falbisoner is licensed under CC BY SA 3.0