Since the American Health Care Act’s passage in the House, the future of U.S. health policy now rests in the hands of the Senate. What happens next is unclear: The Senate’s version of the legislation could move to the left or right, or the chamber could draft an entirely new bill as a starting place. Still, the broad strokes of Republican health-care reform—a repeal of insurance mandates under the Affordable Care Act, massive cuts to long-term Medicaid spending, federal grants for state high-risk pooling, loosening of restrictions on insurers, and a private-insurance tax-credit scheme that makes care more expensive for poor people and the most costly patients—seem unlikely to change.
Given those elements, it’s possible to predict how the GOP’s reform would affect the groups of people most in need of affordable health care. For one such group—children—the AHCA or a similar plan represents a drastic change to how care is typically delivered and how health-insurance coverage works.
One statistic puts the potential impact of the AHCA on children in stark relief: Children make up about a quarter of the U.S. population, but are about half of the entire Medicaid population. They constitute the single largest eligibility group in the Medicaid program and would be affected by changes to its funding structure the most. And the AHCA certainly aims to change that funding structure: Its rollback of the Obamacare Medicaid expansion and its changes to Medicaid financing would slash the program even below pre-Obamacare levels, to the tune of a cumulative $880 billion reduction between 2017 and 2026.