On December 13, the Georgetown University Health Policy Institute posted a commentary on how the repeal of the ACA could affect child welfare children and families. The piece, Top Five Threats to Child Welfare from ACA Repeal was authored by Olivia Golden, Executive Director, CLASP.
Part of January will likely be dedicated to the repeal of the ACA. Much of the internal discussion is on whether a repeal will be accompanied by a replacement. The consensus seems to be that Congressional leaders will enact a repeal that would take place within two to four years. That is because there is no clear plan or strategy to implement a substitute that would provide continued health insurance for the approximate 21 million Americans who now have health care though that law.
As part of this repeal is a decision on the Medicaid expansion. The ACA, after a Supreme Court decision in 2012, made Medicaid expansion to people at 133 percent of poverty a state option. Thirty-one states had taken the option with the federal government providing a 90 percent match in the first years. Before the ACA, Medicaid coverage was a patchwork of eligibility with very limited coverage for any single adults. An ACA repeal could repeal the Medicaid expansion sooner than the rest of the ACA repeal.
The paper by Olivia Golden, highlights the impact of the Medicaid coverage for youth who aged out of foster care and who are now covered by Medicaid to age 26. She also highlights the impact of cutting access to mental health and medical treatment for parents involved with child welfare. Before her position at CLASP, Golden oversaw the Washington DC child welfare system and before that was Assistant Secretary at the helm of Administration for Children and Families, HHS.
According to an analysis by the Urban Institute, if Congress repeals the ACA through the congressional reconciliation process without a replacement plan, up to 29 million people will lose their health insurance coverage. They also calculate that non-elderly people without health insurance will rise from 11 percent to 21 percent. In addition to the Medicaid roll back, Congress could repeal the tax credits through the insurance exchanges, and perhaps repeal the individual mandate as well as some other significant regulations on insurance policies through the reconciliation process.