Dispelling myths about the AHCA

By: Deborah Vishnevsky

As CDHP has previously noted, the provisions in the American Health Care Act (AHCA) are likely to leave tens of millions uninsured while threatening the availability of dental benefits for children and families in both public and private coverage. At the same time, we realize that policymakers are hearing what may seem like compelling arguments in favor of the AHCA — it will offer ”flexibility,” will not significantly impact children, or will spur innovation. Let’s address each of these messages to bring clarity to an otherwise foggy conversation.


Flexibility

While the AHCA does include language that loosens “regulations” around Medicaid and private insurance, but doing so would have troubling costs.

As passed by the House, the AHCA would cut funding to state Medicaid programs via a per-capita cap or block grant system. This decreased funding leaves states with the difficult choice of replacing those funds or, more realistically, limiting eligibility, coverage, and access to care. In addition, under the block grant option, many longstanding Medicaid standards would be waived, including the Early Periodic Screening, Diagnostic, and Testing (EPSDT) standards for comprehensive children’s care, which include dental services.

The AHCA also allows states to waive the ACA’s Essential Health Benefits (EHBs), which determine the services, including pediatric dental, that must be offered by private insurers in the small group and individual markets. If states “take advantage” of this new flexibility by modifying or eliminating EHBs, certain benefits like maternity care or pediatric dental coverage are “likely to be excluded,” according to the nonpartisan Congressional Budget Office.

However, regardless of these proposals, it is worth noting that states already have significant flexibility. The Centers for Medicaid and Medicare Services offer a variety of opportunities for innovation in Medicaid and CHIP. States are even able to apply for waivers to experiment and modify programs at a larger scale to meet their specific needs (for more information on waivers you can watch a webinar on the subject in our Toolkit). Similarly, the ACA already allows states to apply for waivers to improve access, quality of care, and affordability of coverage.

All in all, it would seem AHCA’s changes don’t add much in the way of flexibility but do make it more difficult for many to access affordable and meaningful health coverage while putting benefits, like dental coverage, at risk.


Impact on Children

In the latest episode of our monthly Policy Webinar series (available in our Toolkit), “Reviewing The American Health Care Act: Implications for Children,” we featured experts who examined how the AHCA will impact children.

Aimee Ossman, Vice President of Policy Analysis and Implementation at the Children’s Hospital Association (CHA), contends that the AHCA would definitely impact children. CHA-commissioned research confirmed that “children’s Medicaid [not including programs for disabled children] would suffer a funding cut of $43 billion over 10 years under a per-capita cap model, and as much as $78 billion over 10 years under a block grant.”

For reference, approximately 37 million children depended on Medicaid for health coverage in 2016, that’s more than 1 in 3 American children.

The funding is just one aspect that is alarming. Indeed, changes to EPSDT standards under a block grant could further limit children’s access to vital services including dental care. And changes to other protections and incentives would likely make health care services less accessible even for individuals covered by private insurance. New analysis suggests that the AHCA could increase the rate of uninsured children by 50%.


General statements about the AHCA

There have been more general statements about the AHCA that would take much more time to unpack so instead we offer some context to help you process arguments for or against the AHCA:

  • Under the AHCA, Medicaid will lose $834 billion in funding over the next 10 years. Supporters feel these cuts will make things “more efficient,” but Medicaid programs are already less expensive per-person than private insurance, despite serving “sicker” groups of people. Many states are already making efforts at innovation to improve programs in their states. However, in general it seems that Medicaid programs do better for patients and state revenue, when they have more funding, not less.

  • The AHCA will impact everyone’s health care coverage, not just those on Medicaid. The policies that make for cheaper private coverage for some, may have dire consequences for others and could result in the elimination of children’s dental benefits in some private insurance marketplaces

  • Many important and diverse voices are critical of the effect the AHCA will have on coverage and access, including oral health.

  • More generally, there is no such thing as a perfect policy package, so everyone should be wary of broad statements that celebrate the AHCA without caveats.


What can you do?

It is not too late to let your Senators know that you’re concerned about this bill.

The Senate is currently reviewing the AHCA and may bring it to a vote before the upcoming Independence Day recess (July 3 -7) so it’s important to act soon. Tell them that the facts are clear, and that they should not stand by a bill that leaves children and families behind. To help your efforts, CDHP has updated our Why Dental Coverage Matters Toolkit with new webinars, talking points and banner images to share on social media. We encourage you to use these tools in communicating with your Senators, Governors, and other key decision-makers in your state.

 

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$38 }
Communities save $38 for every $1 spent to fluoridate public drinking water.
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