Congress Should Commit to ‘Do No Harm’ to Children

Bruce Lesley
Jan 15, 2017 · 8 min read

The U.S. Senate voted on two amendments by Sen. Sherrod Brown (D-OH) and Sen. Tammy Baldwin (D-WI) in the wee hours of the morning on Thursday that sought to protect children and young adults from being harmed by efforts to repeal the Affordable Care Act (ACA) or Obamacare.

Sen. Brown’s amendment would have required the Congressional Budget Office (CBO) to certify that any legislative changes to Medicaid, the Children’s Health Insurance Program (CHIP), or private health insurance “would not result in lower coverage rates, reduced benefits, or decreased affordability for children.” If changes were to leave children’s coverage worse off, under Brown’s amendment, that bill could have been subjected to a point of order, which would require 60 votes to pass in the Senate.

In effect, the Brown amendment would have provided a basic protection to our nation’s children by establishing a “do no harm” standard. Leaders in the children’s advocacy community (the American Academy of Pediatrics, Children’s Defense Fund, Children’s Dental Health Project, Children’s Hospital Association, Family Voices, First Focus, and National Association of Pediatric Nurse Practitioners) specifically called for such a standard in a letter to congressional leaders in early January. As the groups urged:

Congress must reaffirm its commitment to ensuring a stable health care system for all Americans and build on the gains that have been won for children and families, without interruption, and without losing ground.

Unfortunately, despite numerous promises by President-elect Trump and congressional leaders that “no one” will be harmed by “repeal”, the Brown amendment failed by a 49–49 vote (Roll Call Vote #25, 115th Congress).

Sen. Baldwin’s amendment would have created a similar point of order against legislation that would reduce the number of young Americans enrolled in public or private health insurance by either weakening dependent coverage of children up to age 26 under the Affordable Care Act or increasing premiums or out-of-pocket costs for young Americans.

As Baldwin explained, 6.1 million young adults gained insurance coverage under the ACA because the law allows young adults to stay on their parents’ health plan up to age 26 and provides premium tax credits and cost-sharing assistance to young adults purchasing care on their own.

Furthermore, Baldwin’s amendment would have protected an ACA provision that allows more than 20,000 former foster care youth, who age out of care annually, to retain their Medicaid coverage until the age of 26. That provision would also be potentially threatened by a repeal of Obamacare.

Again, despite promises by proponents of Obamacare repeal that “no one” will be harmed, the amendment failed by a vote of 48–50 (Roll Call Vote #12, 115th Congress).

First Focus Campaign for Children strongly supported these amendments because children and young adults are, far too often, an afterthought by Members of Congress when they pass legislation. Even in the ACA, there is a provision referred to as the “kids’ glitch” or “family glitch” because the tax credits under the law fail to take into account the added costs to a family plan caused by dependents. This precludes some families from receiving tax credits to help subsidize their coverage, even though the cost of family coverage may be otherwise unaffordable.

And, in previous efforts to repeal Obamacare, incredible harm would have been inflicted upon children, even if unintended. For example, an amendment by Rep. Steve Scalise (R-LA) to a Continuing Resolution in 2013 would have repealed Obamacare, but also would have slashed $13.3 billion, or 70 percent, out of CHIP.

The House of Representatives passed the Scalise amendment and the health coverage of millions of children would have been eliminated if it had been signed into law. As we said at the time, “Unintended or not, the consequences here would be devastating for children and state governments. Before lawmakers cast a vote for this proposal, they should make sure they understand what they’re voting for.”

The Brown and Baldwin amendments would have helped ensure that children and young adults are not left worse off — intentionally or not — by changes that Congress proposes to the ACA, Medicaid, and CHIP this year.

These amendments were also completely consistent with the rhetoric of some Republicans in Congress and by some in the forthcoming Trump Administration. For example, Kellyanne Conway, senior advisor to Trump, said that no one will lose coverage in the Republicans effort to repeal the ACA. As she said on MSNBC’s Morning Joe on January 3, 2017, “We don’t want anyone who currently has insurance to not have insurance. Also, we are very aware that the public likes coverage for pre-existing conditions. There are some pieces of merit in the current plan.”

On the same day, Senator Bill Cassidy (R-LA), who recently secured a seat on the Senate Finance Committee that will be tasked with instructions to craft the legislation repealing the ACA, said something very similar. He tweeted, “Many are worried about losing insurance coverage. If we repeal #Obamacare and #ReplaceNow no one will lose coverage.”

The President-elect himself, after meeting with President Obama and in an interview with Lesley Stahl on 60 Minutes after the election, had also pledged to not allow the health coverage of people to lapse with the repeal of the ACA. He specifically added that he would work on protecting coverage for people with pre-existing conditions and coverage for young adults to stay on their parents’ insurance plan until age 26.

And, on the issue of pre-existing conditions, Trump had made a similar commitment in a February 2016 Republican debate when he said, “I want to keep pre-existing conditions [the provision prohibiting insurers from denying coverage]. I think we need it. I think it’s a modern age. And I think we have to have it.”

Even earlier, back in May 2015, Trump committed via Twitter during the presidential campaign that “there will be no cuts to Social Security, Medicare and Medicaid.”

These are all pretty clear statements and important to children. If these commitments are reflected in forthcoming bills, then nobody should lose coverage with the repeal of the ACA, including people with pre-existing conditions and children covered on their parent’s health plan until age 26, and there will be no cuts to Medicaid. For low-income children and children with special health care needs, including those in foster care, these words are particularly important and potentially comforting. But unfortunately, those words may be meaningless.

The problem is that Trump’s Department of Health and Human Services designee Tom Price, others on Capitol Hill, and the Cato Institute’s Michael Cannon are not on the same page with these statements. Furthermore, if you repeal provisions in the law like the coverage mandates, protecting coverage for people with pre-existing conditions can appear on paper but not in operation because such coverage could become unaffordable through the creation of an insurance death spiral.

Congress and the Trump Administration should be extremely cautious as they prepare to undertake a rather complicated “repeal and replace” process that they have committed themselves to. As the Washington Post’s Paul Waldman writes, “These are literally life-and-death questions Congress is deciding.”

As an example, teacher Cole Gelrod’s daughter, Juniper, was born with a relatively rare condition that required her to need a heart transplant and her health coverage was life-saving. Gelrod explains:

Juniper’s medical bills throughout the first year of her ordeal totaled more than $3 million. Because of Obamacare and the fact that we live in a state that embraced it, she qualified for a Medicaid waiver. Once this waiver came through, our financial burden was mostly lifted. Additionally, we did not have to worry about the fact that she might not ever get covered, or be forced to pay ridiculous premiums, or hit a lifetime maximum payout within the first few months of her life. The donor, donor’s family, doctors, nurses, specialists and medical technology saved our daughter. Obamacare saved our family.

Like Juniper, the health and well-being of millions of children are at stake. After passage of CHIP in 1997, the federal government and states worked together on a two-decade long, arduous journey to reduce the uninsured rate among our nation’s children. Consequently, CHIP, in partnership with Medicaid, has led the successful drive to cut the uninsured rate for children from around 15 percent in 1997 down to less than 5 percent in 2015. This translates into a 68 percent reduction in the uninsured rate of children over the period.

That is an enormous, and yet, often unheralded success story, as millions of children across this country are now better able to receive access to treatment for a chronic illness, a serious life-threatening medical condition like cancer, or preventive care such vaccinations and annual check-ups. Those long, hard-fought games should not be wiped out on a whim or without full consideration as to the implications of forthcoming “repeal and replace” efforts by Congress.

For example, during consideration of the ACA, which took 15 months in 2009–2010, Congress still made mistakes in the drafting of the legislation — with the “kids’ glitch” or “family glitch” serving as one example. Ironically, some of the Members of Congress who claimed the ACA was “rammed” through Congress too quickly are now pushing to have a “repeal and replace” bill passed with great urgency, even though there currently is nothing even close to an agreement on how, what, or when to repeal and replace the ACA.

Now is not the time to backtrack on two decades of progress with respect to children’s health coverage. Congress should commit to “do no harm” to the health coverage of our nation’s children. As Senator Brown said:

Ohio children need access to doctors and care from the start so they can grow into healthy adults. More children now have care than ever before and now is not the time to leave parents scrambling to figure out how they’ll care for their children when they’re sick.

Without these protections for children, Sen. Bob Casey (D-PA) voted in opposition to the budget proposal. Children need more policymakers, like Sen. Casey, who are willing to take a stand to ensure that the health and well-being of children are a priority and are not left worse off.

Furthermore, we need policymakers to commit to not “hold hostage” the health of over eight million children in CHIP in order to pursue potentially harmful changes to either Obamacare or Medicaid. Unfortunately, in a recent Washington Post story, Mike DeBonis reports:

According to multiple GOP sources, Republicans are looking at whether to use reauthorizations of existing programs, such as the Children’s Health Insurance Program, as vehicles for replacement measures. That could give them leverage to secure cooperation from Democrats.

It is unacceptable that either party would play politics and take children’s health and well-being hostage in order to push a partisan political agenda, but this is something that CHIP has repeatedly faced in the past, such as during consideration of CHIP reauthorization a decade ago. This concern was also one of the reasons why nearly 1,600 organizations pressed for a clean, four-year funding extension of CHIP in 2015 rather than the two-year extension that CHIP was granted.

Fortunately, as Jonathan Chait wrote in the New York Magazine, if congressional leadership pursue efforts “to give people cheaper, skimpier insurance than Obamacare care offers” by threatening “to end of the Children’s Health Insurance Program,” it would be quite unpopular with the American people. As such, we need to preempt such talk and consideration now.

Consequently, as the debate moves to the next stage, we ask that you call or write your congressman and senators and urge them to:

(1) commit to a “do no harm” standard with respect to children and health reform. Congress should guarantee that children will not be harmed before taking actions that could radically transform our nation’s health care system and potentially undo years of progress that has been made in children’s health coverage;

(2) oppose any and all “hostage taking” of children’s health coverage in an attempt to extract concessions from their colleagues on potentially unpopular or detrimental pet projects; and,

(3) pass a clean, long-term extension of CHIP in the first 100 days of the Congress.

Children deserve nothing less.

Bruce Lesley

Written by

@BruceLesley — President of @First_Focus & @Campaign4Kids. Child advocate, husband & father of 4. Basketball fanatic. Follow on Twitter: @BruceLesley.

Voices4Kids

Forum for child advocates to raise important, but often neglected, issues and advance policy change that would improve the lives of our nation's children.

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