The Affordable Care Act has been under regular attack from the moment President Obama signed it into law in 2010. One of the most recent sabotage efforts is the health care repeal lawsuit known as Texas v. U.S. This case, brought by a coalition of states, is an effort to take away health insurance coverage and consumer protections from millions of Americans. If the Texas coalition succeeds, the outcome would be devastating to children and their families.
Research confirms that uninsured children experience poor health outcomes more often than children with insurance. Although overturning the ACA would likely lead to coverage losses among low-income children of all races and ethnicities, it would have a disproportionate impact on children of color. This is true especially if the court repeals the ACA in just the Texas coalition states. The Texas coalition has significant percentages of Black and Latinx children residing in their states, and a disproportionate percentage of them obtain health insurance through Medicaid and CHIP. Three of the Texas coalition states are also among those states with highest number of American Indian/Alaska Native (AI/AN) children. Even with the ACA, AI/AN children are more than twice as likely to be uninsured as U.S. children overall. Repealing the ACA puts these children at even greater risk of losing coverage and would likely exacerbate disparities in access to health insurance.
In addition to undermining our effort to reduce coverage disparities, the health care repeal lawsuit would also reverse some significant but lesser known aspects of the ACA that benefit children. A recent report describes these provisions which include:
- Maintenance of Medicaid and CHIP eligibility for children. The Affordable Care Act stopped states from lowering income eligibility for children or making it harder to enroll. When CHIP was re-funded in 2018, this provision laid the groundwork for Congress to extend the requirement through 2027. Overturning the ACA will likely permit states to immediately cut child eligibility.
- Simplified Medicaid and CHIP eligibility and enrollment. The Affordable Care Act streamlined Medicaid and CHIP eligibility and enrollment, which made it easier for children to obtain coverage. Up until recently, these requirements contributed to historic gains in coverage. Unfortunately, we have seen declines in enrollment the last couple of years. Losing the ACA’s simplified systems and procedures could worsen this decline and result in even more children losing coverage.
- Medicaid coverage of former foster youth. The ACA required states to provide Medicaid coverage to individuals leaving foster care up to age 26. This was particularly important since former foster youth are more likely to be uninsured and may have more complex health needs than other young adults. This requirement would be eliminated if the ACA is struck down potentially reducing the number of former foster youth who have insurance coverage.
- Reforms to improve access and quality for children. The ACA created the Center for Medicare and Medicaid Innovation (CMMI), which is charged with testing new ways to provide and pay for health care. CMMI recently announced funding opportunities to test approaches focused on children and youth (called Integrated Care for Kids or InCK) and on pregnant and postpartum people with opioid disorders (called Maternal Opioid Misuse or MOM). Repealing the ACA would mean eliminating CMMI and potentially forgoing the opportunity to develop more effective ways to provide health care services to children and their parents.
The provisions above specifically impact children. But kids don’t live in a vacuum. Research shows that the potential loss of coverage for both children and their parents jeopardizes children’s long-term health and development. Moreover, losing coverage would also put children and their parents at risk of going without needed medical care and incurring significant medical debt for any care they do receive. Financial insecurity doesn’t just affect adults—children’s development can be negatively affected by issues resulting from poverty, such as toxic stress.
The bottom line is that the health care repeal lawsuit is bad news for children and families. We encourage you to learn more about the case using our timeline and explainer video and find out how it could affect people in your state with our state-specific fact sheets. But don’t stop there. Take action to push back against this harmful lawsuit by contacting your state’s Attorney General and using Community Catalyst’s sample op-ed to raise the issue in your local media outlets.
This blog was written with assistance from Community Catalyst intern Julia Coddington.