This blog is part of a series that will highlight how structural racism in the health care system negatively affects the health of individuals of color. Community Catalyst is committed to exposing and dismantling policies, practices and attitudes that routinely produce cumulative and chronic adverse outcomes for people of color in the health system.

The American Health Care Act (AHCA), as passed by the House of Representatives and sent on to the Senate, would make draconian cuts to Medicaid funding and reduce the federal minimum eligibility level for children ages six to 19 from the current 138 percent, to 100 percent, of the federal poverty level. That translates to an income of $20,420 or less for a family of three. These changes would reverse the progress on children’s coverage that has been made through the ACA and dramatically undermine critical services for children and families across the country, especially low-income children and children with special needs. Data continues to emerge as to how terrible this bill is – from estimates on the burden it would place on state budgets to the financial impact on schools that provide health services to children enrolled in Medicaid, resulting in reduced access to care, especially for children with disabilities. The Congressional Budget Office’s newly-released estimates confirm both the financial losses for states and the human impact of the AHCA—14 million could potentially lose their access to Medicaid by 2026.  

Today, in a new report, the Institute for Child, Youth and Family Policy at Brandeis University – explores the racial and ethnic breakdown of these potential coverage losses for children. The results are stunning for Black and Hispanic children across the country.

The fate of the House bill now rests with the Senate.



What does the data show?

Both the actual number, and disproportionately high share, of coverage losses for Hispanic and Black children is significant nationwide, with some of the greatest impacts concentrated in Southern states. The table below shows the top ten states facing a decline in number of children that meet the federal eligibility minimum:

<p>California, Texas, Florida and Georgia are among the states with the largest declines in the number of children eligible for Medicaid under the House version of the AHCA, ranging from 462,500 Hispanic children in California to 88,200 Black children in Florida (Table 2). Looking at these numbers expressed as the percentage of children of color in a given state who would lose access to their current Medicaid coverage paints the threat more starkly. Tennessee would be the state with the largest decline in the percent of Hispanic children federally eligible for Medicaid under the AHCA proposal, with a 20.4 percentage point decline, followed by Wisconsin at 19 percent. For Black children, Utah and Kansas rank first and second in their percentage point decline in children federally eligible for Medicaid, at 17.3 percent and 15.9 percent, respectively.</p>
<p><img decoding=Early Periodic Screening Diagnosis & Treatment (EPSDT) benefit that ensures access to critical preventive services and care. In sum, this step backwards for our country would explicitly and disproportionately harm children of color in the near-term and exacerbate troubling long-term health inequities across our country that many of the ACA’s provisions have just started to address. 

What can advocates do?

Advocates can take a dive into their own state-level data to understand the health equity impact of the school-aged proposed rollback. Learn more about your state here. Amplify the data and tell the personal stories of children in your state. Be specific about which racial and ethnic groups will suffer and could lose access to important preventive services because of AHCA. Effective storytellers can include teachers, school nurses, caregivers, providers, parents and youth. Policy makers need to hear from us to help them fully understand how their actions on this dreadful piece of legislation will determine the future of progress on health equity in the United States.