First, Do No Harm

Currently, under the Affordable Care Act (ACA), nearly all children in America are covered with health care and have access to services that keep them well and able to learn in school.  As Congress negotiates over the next few weeks, however, on how to repeal, replace or repair the current law, the well-being of millions of children is at risk.

Children would be greatly harmed if they lose coverage, and Maryland families may find it more difficult to access the care their children need.

While much has been reported about the Congressional Budget Office’s estimates of the over 20 million people who will lose their health care if the House or Senate bills become law, less has been discussed about the devastating effects on children. Children would be disproportionately affected by any changes to the program because they represent the largest group covered by Medicaid: 39% of all children compared to 12% of all adults. They would suffer tremendously under these proposals due to the huge caps and massive cuts to federal Medicaid funding, especially the 76% of all poor children who receive Medicaid.  Children of moderate-income families would also be affected by the reduction in tax credits that help them afford coverage in the individual market.  To add to the trauma, states would be incentivized to decrease services and enrollment as they wrestle with managing their own budgets. In addition, children would also be affected by the repeal of Medicaid expansion for low-income adults, which cover millions of low-income parents and have resulted in greater participation among eligible but unenrolled children.

Additionally, with the conversion of federal funding to Medicaid block grants, states would no longer be required to cover a critical piece of Medicaid for children: Early and Periodic, Screening, Diagnosis and Treatment (EPSDT). EPSDT provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid to ensure they receive appropriate preventive, dental, mental health, and developmental, and specialty services essential for healthy childhood growth. These include immunizations; developmental, physical, and mental health screenings (including for vision, dental, and hearing services); follow-up services if a risk is detected; and periodic and regular doctor visits. EPSDT benefits provide supports for our most vulnerable children, who are disproportionately affected by obesity, increased blood lead levels, asthma, trauma, adverse childhood experiences and other health problems. Children with the EPSDT benefit are able to access well-child visits as often as privately-insured children and more often than children who are uninsured.  This is especially important to the 60% of all children with disabilities who rely on Medicaid.

Wealthy individuals and corporations are poised to receive billions of tax cuts in both the House and Senate versions of the healthcare bills that are up for consideration.  By contrast – in same versions of those bills – millions of children who are currently insured will lose access to health care, and children born in the future will have poorer access.  Providing our children with the preventative care they need isn’t just a moral obligation; it’s also a smart, common sense investment.  It is an investment that stops adverse health conditions from becoming more significant and costly during adolescence or adulthood. The impact on child development must be considered, as policymakers debate new health care proposals – including changes to Medicaid.  Healthy children are happy children.  Healthy children learn better.  No one disagrees that changes in healthcare are needed.  But first, do no harm.

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Ready At Five improves the practice and quality of early childhood education in Maryland.


We believe that every child in Maryland should have the foundational skills needed for success in school, career and life.

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