Why doctors say 'AHCA' stands for the 'America Hates Children Act'


Mitch McConnell's secret healthcare plan would be a disaster for America's children [AP Photo/J. Scott Applewhite]

The America Hates Children Act.

That's what some of my colleagues are appropriately calling the legislation (American Health Care Act or AHCA) the House passed last month and the GOP leaders in the Senate are trying to push through without a single public hearing.

Too harsh? I don't believe so. Even our president has called the bill “mean.” And now that the Senate has released its first draft, it is worth calling out the cruelties in the bill as they relate to children.

So how bad is it? To start, by allowing states to change what constitutes an “essential” benefit for health insurance, both the House and Senate AHCA open the door for annual and lifetime limits on what insurance companies will pay. This means babies born premature or with congenital diseases (diseases from birth) could reach their lifetime/annual limits before ever going home for the first time. In the U.S., about 390,000 children are born premature each year, about 5,600 of them in Minnesota. Essential benefits also make sure prenatal/pregnancy care is covered. Stripping that insurance coverage will impact our children’s health before they even enter the world.

If that weren’t enough, any baby having to spend time in the intensive care unit could be marked with the insidious “pre-existing condition” label. The House version of the AHCA allows states to remove protections for those with pre-existing conditions, letting insurance companies mark up the price of insurance so high that your premie child won’t have access to potentially life-sustaining medical care. (The Senate version keeps these protections intact, for now.)

But the real way this bill shows its contempt for children is its determination to dismantle Medicaid. All forms of the law being discussed aim to gut Medicaid either now or over the next decade. In total, Medicaid helps to provide access to care for more than 30 million children in the United States, and nearly 400,000 here in Minnesota. Beyond basic access to care, Medicaid either directly or in part covers almost half of all children with special healthcare needs, like kids with Down syndrome, autism, or cerebral palsy.

Medicaid also helps pick up the cost for expensive but life-saving treatments for children with cancer and other serious diseases. Prior to the Affordable Care Act (Obamacare), children with pre-existing conditions were at least able to get coverage via Medicaid. Additionally, most children’s hospitals get a significant amount of their revenue from Medicaid. Drastic cuts will impact the ability of these institutions to provide high quality care and develop new procedures that lead to the medical miracles we have come to expect.

Lastly, the AHCA plans to dramatically change the way Medicaid is funded at a state level by instituting either a per-capita cap or a “block grant,” which will limit how much a state gets for Medicaid based on the previous year’s budget. If that happens, AHCA will impair states’ abilities to fight public health crises like Minnesota’s recent measles outbreak.

Over half of the children and families I care for depend on Medicaid. If the AHCA were to pass, those children and families would not have direct access to the measles vaccinations that have helped slow the spread of a deadly virus.

Now you see why we call it the America Hates Children Act.

To recap, the AHCA promises to remove protections for pregnant mothers and the children they carry; strikes protections for children born prematurely or with a disease; ends a national safety net program that pays for care to millions of children; takes away critical support for children with disabilities, special needs, and cancer; cripples children’s hospitals; and increases the risk that the next public health crisis hits every family in Minnesota.

This isn’t a healthcare act at all, because that includes the word “care.” The AHCA is a cold, heartless piece of legislation. If it is passed by the Senate and signed into law by our president, our government is sending a clear message that the future they envision is one where America hates our children. Our children don’t deserve the health conditions many must endure. They very certainly do not deserve the further cruelties of the AHCA.

Nathan Chomilo is a pediatrician and internist in the Twin Cities and a board member of Minnesota Doctors for Health Equity, a group that works to advance health equity through legislative, community, and institutional engagement.

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