Three million and $1.6 trillion. The first number represents an estimate of the children who would lose healthcare coverage under the bill Republican senators worked on in secret and finally unveiled on Thursday. The second number reflects the total amount of Medicaid cuts — in the form of the elimination of the Medicaid expansion for working families that was part of the Affordable Care Act, capped federal spending for Medicaid and additional cuts proposed in the president's budget — that would go to pay for tax breaks for billionaires.
As with the House version of the American Health Care Act — also written in secret and passed in reckless haste — the Senate revision would end Medicaid as we know it. In essence, Trumpcare would abandon the federal government's 52-year responsibility to guarantee healthcare for those unable to afford it on their own.
If Republicans succeed in passing this legislation, millions of parents who work hard but struggle to make ends meet will find it prohibitively expensive to get their children the care they need. Millions of earaches will go untreated, leading to hearing loss. Those who can't see the blackboard in school won't receive eyeglasses. Treatable illnesses will turn into hospitalizations. Some will die; one study found that in-hospital mortality rates are 60% higher for uninsured than insured children.
And suffering most of all will be the 60% of children with disabilities — and their families — who currently receive Medicaid coverage. Insurance companies will not be eager to step in to cover them.
I'm thinking of children such as Spencer, who lives in Indianapolis, an 11-year-old who experienced a stroke in utero. Multiple surgeries were required to correct problems with his arms and legs and left him with autism, behavioral problems, seizures and a blood-clotting disorder.
Thanks to Medicaid, Spencer has access to what's called applied development analysis therapy, the most effective autism treatment available. Some of it is covered by the Indianapolis school system, but most is paid for by Medicaid.
Because Spencer's health often requires his mother, Erica, to take time off work, she has struggled to keep a full-time job. Today, she is covered through Medicaid, too, which allows her to take care of herself while she cares for Spencer.
Erica says the legislation moving through Congress has left her "stressed to the max." Sadly, she has good reason to feel that way. If it becomes law, she and Spencer could be kicked off Medicaid — Indiana may take an option available under the American Health Care Act to stop covering the therapy so essential to his health, or it simply may not be able to pick up the additional costs if the law is passed and Medicaid cuts become reality.
We have a moral responsibility to protect the well-being of children. That's why when I was chair of the House health subcommittee, I authored several bills in the 1980s and '90s expanding Medicaid coverage for children and strengthening their benefits.
These vital gains will be reversed if Congress shifts the financial responsibility for Medicaid from the federal government to the states through a per capita cap. Such a proposal would not merely repeal the Affordable Care Act, it would also fundamentally change the much longer-standing, successful program for working families, children, people with disabilities and the low-income elderly. And the effects will be felt beyond the individual loss of health coverage.
The cuts to Medicaid funding are so steep that many safety-net hospitals and clinics would be forced to close. This would be an unmitigated disaster for rural communities, where healthcare options are few and far between, leaving residents with less access to care where and when they need it.
For states to deal with the large budget shortfall that would result from caps on federal Medicaid dollars — which will increase each year under the current proposal — they would have to raise taxes, or make cuts in other areas such as education or infrastructure or, most likely, keep cutting Medicaid benefits, eligibility or payments to providers.
In the Senate's discussion draft, the working group attempts to protect children with special healthcare needs from Medicaid caps by maintaining the current match rate that applies to them. But to shield children with special healthcare needs while also balancing its budget, a state would have to make much deeper cuts in care for other children, parents and working adults on Medicaid.
Legislation needs to pass sufficient public scrutiny or it's unworthy of becoming law. If monumental, transformative legislation can be written in the dark and enacted in a rush— and children's lives are compromised or ruined so that billionaires can get tax cuts they don't need — it would rank among the worst scandals in U.S. history. Americans of conscience must mobilize now to stop this from happening.
Henry A. Waxman, past chairman of the House Energy and Commerce and the House Oversight and Government Reform committees, represented California's 33rd Congressional District from 1975 to 2015. He's currently chairman of the public affairs firm Waxman Strategies.