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    Red state, blue state: What the election may mean for kids

    The outcome of this year’s presidential election could significantly change the federal government’s role in addressing children’s health.



    Children’s Health Insurance Program covers 8.4 million children. Clinton has been a staunch supporter of the program. Although her exact role in its genesis is somewhat in dispute, Clinton has energetically worked to reauthorize it. She has shown a keen interest in children’s issues in general, beginning early in her career when she served as a staff attorney at the Children’s Defense Fund.

    The CHIP’s current funding expires September 30, 2017, and given her record on the program, Clinton could be expected to make reauthorization a priority if she were president.

    Trump has said little on the topic, nor does he have a track record of showing interest in public policy specifically related to children. However, on his website he implies that Medicaid and CHIP would become less necessary if he is elected.

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    “To reduce the number of individuals needing access to programs like Medicaid and Children’s Health Insurance Program we will need to install programs that grow the economy and bring capital and jobs back to America,” his website says. “The best social program has always been a job—and taking care of our economy will go a long way toward reducing our dependence on public health programs.”

    Affordable Care Act

    The 2 candidates have taken opposite positions on the ACA, with Trump promising to repeal it and Clinton promising to defend it.

    Simply repealing the ACA would reduce the number of insured Americans by 19.7 million, according to the Rand Corporation analysis. The analysis did not break down the effects by age group, but Alker estimates that about 1 million children are currently insured through the insurance exchanges set up by the ACA. Children are underrepresented in the exchanges compared with the general population because so many are covered by Medicaid and CHIP, she says.

    Repealing the ACA could also affect children by eliminating a couple of provisions aimed specifically at children:

    ·      It requires states to maintain their current eligibility levels of children’s coverage in Medicaid and CHIP through September 2019.

    ·      It requires states to keep children aged 6 to 18 years with family incomes between 100% and 138% of the federal poverty level in Medicaid rather than CHIP. This eliminates insurance premiums for these families.

    Charging premiums reduces enrollment by low-income families, Alker says.

    Other proposals

    Trump has proposed to “replace” the ACA with a set of other initiatives. Apart from the broad package of economic reforms that he claims would reduce the number of people needing government assistance, he would expand tax deductions for healthcare costs, allow insurance companies to offer plans across state lines, allow the import of drugs from overseas, broaden the use of tax-deductible health savings accounts, and require more transparency in healthcare costs.

    Would these policies compensate for the loss of coverage through ACA and Medicaid? According to the Rand analysis, the combined effects of repealing the ACA, expanding tax deductions, paying for Medicaid through block grants, and allowing insurers to sell across state lines would result in a net reduction of 20.3 million persons (adults and children) losing healthcare coverage.

    Rand does not attempt to analyze Trump’s other proposals. A 2005 analysis by a researcher at Columbia University, New York, found that health savings accounts were unlikely to expand health insurance coverage because most uninsured people are not paying high enough taxes to benefit from the deductions.

    NEXT: Divided government


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