March 15, 2019
The President’s new, 2020 budget request
to Congress unfortunately revives many of the troubling policies from last
year’s proposal. It signals the administration’s intent to continue advancing
health care changes that could put children and families’ oral health and
financial stability at risk. While the budget proposal would require
congressional action to take effect, it highlights the Administration’s
priorities to reduce government spending by cutting crucial benefits and
protections for families. Most concerning, some of these proposals could further erode children
and families’ access to oral health coverage and care.
As with the President’s previous budget,
the 2020 plan calls for the passage of 2017’s Graham-Cassidy-Heller-Johnson (GCHJ)
bill. It would place spending caps on state Medicaid programs, ultimately
slashing program funding by $1.5 trillion over 10 years. In addition, the
proposal would eliminate private insurance protections, weakening the
Affordable Care Act’s (ACA) essential health benefit requirements. These standards
ensure coverage of children’s dental services in plans that adhere to the
health coverage law. Ending these ACA rules would also effectively eliminate
protections for people with pre-existing conditions. The massive cuts to
Medicaid would force states to make difficult decisions about who and what to
cover. Experience has shown us that cuts to Medicaid are often associated
with cuts to adult dental benefits in
state programs. Moreover, the Congressional Budget Office pointed out that bills similar to the
GCHJ plan would result in millions more uninsured people. Such measures would
also make pediatric dental coverage an easy target if private insurers are no
longer required to cover the full range of essential health benefits.
Some of these proposals could further erode children and
families’ access to oral health coverage and care.
This budget also touts efforts to “empower” consumers by expanding
the availability of cheaper and less comprehensive private insurance plans.
Although they are thriftier, these options come at the cost of valuable
protections. For example, the administration highlights recent regulation
changes that allow for the sale Association Health Plans (AHPs)
and Short Term Limited Duration
Health Insurance (STLDI). While AHPs and STLDIs may present
cheaper sticker prices for families, both are less likely to meet the needs of
children and families especially when it comes to oral health care. These
insurance plans can skirt ACA standards, which may lead to families being stuck
with plans that don't cover children's dental care and leave them facing medical debt.
In fact, the House Energy and Commerce Committee is currently investigating short-term
plans for misleading marketing practices.
Another troubling component of the President’s budget would require
all states to impose onerous work and reporting requirements on
adults in order to qualify for Medicaid coverage, with limited exceptions. Many
of the adults eligible for or enrolled in Medicaid are already working, and
Medicaid coverage has been found to help adults find and keep jobs.
Similar state-level work requirements have shown that this would almost
certainly result in loss of coverage for
many low wage adults. Yet the budget document counts on these coverage losses
for at least $130 billion in savings. In reality, work reporting
rules will require substantial investments in
the administration of state Medicaid programs. At the same time, they would
likely lead to more uncompensated care in
local hospitals when individuals struggling to get by, now unable to get
covered, still need care — all of which could increase costs for state
taxpayers.
As CDHP has previously highlighted,
barriers like work requirements put the health and well-being of both parents
and children at risk. When parents have health coverage, their children are
also more likely to
have coverage. Yet when these benefits are cut, low-wage families are more
likely to experience deeper poverty and medical debt,
in turn exposing children to toxic stress and undermining their access to care.
Dropping people from Medicaid also pushes oral health care out of reach.
Lawmakers should note, in contrast to these flawed claims of savings, improving access
to dental services could have far-reaching benefits for families and
communities. Parents with access to oral health care are more likely to access
care for their children and
good oral health has been shown to promote higher incomes. In short, to effectively
support children, we must also support families.
It is worth reiterating that this budget will not likely be adopted
by Congress. But, this document outlines the goals of the administration, the
concessions they are willing to make, and some of the tactics we may expect
from the Department of Health and Human Services in the coming months.
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