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Scrapping Medicaid Expansion Could Affect Poor School Children

As more governors pledge to back off of federal plans to expand Medicaid—and with Maine's governor planning to cut current Medicaid rolls—children's health advocates warn of a rollback in the progress made in insuring poor children.

Considering that research shows that children's health is directly tied to their ability to learn, a drop in the number of children with health insurance could have a major effect on students' performance at school.

But some Republican governors have seized upon one part of the U.S. Supreme Court ruling on the Affordable Care Act earlier this month that says states cannot be threatened with a loss of existing Medicaid dollars if they refuse to participate in an expansion of the health care program for the poor. They have said they will not expand the program in their states.

In a new memo, the Center on Budget and Policy Priorities and the Georgetown University Health Policy Institute's Center for Children and Families outline the potential effects if Florida, Texas, Wisconsin, and other states decline to expand Medicaid—an expansion in which the federal government would pick up all or nearly all of the tab for years. The expansion would allow many low-income families not eligible for Medicaid to qualify. These families wouldn't be able to get help buying insurance from healthcare exchanges, so without an expansion, they would likely continue to lack access to coverage.

While the federal Children's Health Insurance Program has helped increase the number of poor children with health insurance, coverage for the parents of these children is also critical, the groups said.

For example, they said, low-income families are three times as likely to have children who are eligible for insurance but who don't have coverage than families where parents are covered by private insurance or Medicaid. And previous expansions of Medicaid coverage for parents have led to significant increases in the enrollment of eligible children and subsequent decreases in uninsured children.

Estimates of just how many parents would be eligible for coverage in some states, based on children's enrollment in Medicaid or CHIP, are available here.

Also, studies have found that covering parents makes it more likely that children's coverage by Medicaid and CHIP remains steady, the groups said.

These statements echo a previous report by the Center on Budget and Policy Priorities that long preceded the 2010 Affordable Care Act. The nonpartisan Center, based in Washington, works on fiscal policy and public programs that affect low- and moderate-income people.

When parents have poor physical or mental health, the groups note, the Institute of Medicine has reported that they may cause a stressful family environment that can impair children's health. In addition, uninsured parents may turn to expensive forms of treatment—such as emergency rooms—winding up with big bills that also can have a negative effect on their children.

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