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Repeal of the federal health care reform law, known as the Affordable Care Act (ACA), would cause the number of children who are uninsured to more than double, according to a new report. The study released on December 21 by the Urban Institute projects that repealing the ACA without developing a viable replacement plan would result in an increase of 4.4 million additional uninsured children (ages 18 and under).

Unfortunately, that’s not a worst case scenario; the report contains estimates of much larger increases in uninsured children under other possible changes in federal policy that could be coupled with or follow on the heels of ACA repeal.

Most analyses of the ACA have focused on the effects for adults because adults were far more likely to be uninsured prior to the law’s implementation. Because kids were already benefiting from the Children’s Health Insurance Program (CHIP), their uninsured rate had been steadily declining for more than a decade. But the new analysis helps illustrate that the ACA has built on that progress and has significantly improved health care coverage for kids.

According to the new study, the uninsured rate for children would be just 4.1% in 2019 under current law, but they project that rate would jump to 9.6% in 2019 if the ACA is repealed. For Wisconsin, the Urban Institute estimates that the number of uninsured children would increase from 49,000 (3.6%) under current law to 96,000 (6.9%) if the ACA is repealed and not replaced, and the number or uninsured parents would jump by 63,000 (a 91% increase).

Some of the other findings relating to ACA repeal include the following:

Eighty-eight percent of children losing coverage would be from working families, and 900,000 would be under the age of 5.

The majority (54%) of the children losing coverage would be white.

The number of uninsured parents would increase nationally by 7.6 million in 2019 – an increase of 113% – and more than 85% of parents who would lose coverage are working full or part-time.

Children who retain their insurance would also be harmed by repeal of the ACA because they would lose many of the other gains from the law, such as improved access to preventive services and the elimination of annual caps on the cost of health care services.

The new report also looks at a couple of scenarios in which federal lawmakers go even further and end other federal laws that have very substantially improved health care coverage for kids. For example, they estimate that ending the Children’s Health Insurance Program could cause the number of uninsured children to more than triple – jumping to 178,000 in Wisconsin – if the ACA is repealed. Funding for CHIP will run out on September 30, 2017 if Congress takes no action to extend funding.

The Urban Institute report also estimates the effect of repealing the “maintenance of effort” (MOE) provisions, which have required states to maintain income eligibility standards for children in Medicaid and CHIP. The MOE provisions are currently in effect until 2019, but previous ACA repeal bills have proposed eliminating them in 2017. The report indicates that if all states rolled back their Medicaid coverage to the minimum level that would be required in the absence of MOE standards, the number of uninsured children would increase to about 207,000 in Wisconsin, more than four times the current level, and it would surge by about 10 million nationally.

Looking ahead for the next three to five years, I can’t imagine Wisconsin reducing its Medicaid coverage of children by anything close to that amount. Nevertheless, I think it’s very relevant to consider those estimates of how large the reductions in children’s coverage could potentially be. One of the proposals federal lawmakers will offer next year is to change Medicaid funding to a block grant, and the last block grant bill introduced by House Republicans would have gradually reduced Medicaid funding by 33% over a 10-year period. Federal funding cuts of that magnitude would force states to make very deep cuts in Medicaid eligibility and services, and the cuts in children’s coverage would probably be far greater than anything we can now imagine.

Read more about the effects of ACA repeal in WCCF’s brief fact sheet about what repeal without replacement would mean for Wisconsin, and see also this three-page Wisconsin fact sheet prepared by the Department of Health and Human Services.