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By Rob Thompson

universal-img-momandinfantdaughterLast week’s election changed the landscape for many important issues facing our state and nation—not the least of which is health insurance coverage for millions of children and parents in North Carolina.

With President Obama set to leave office in January, Congress and President-elect Trump are poised to make major changes to the nation’s most critical health care programs and policies for children. But before the overhaul begins, we hope they’ll think about the immense progress we’ve made in improving the health of children over the past twenty years.

Good health is the foundation for children’s future academic, economic, and socioemotional success. Health insurance coverage is a fundamental first step in helping children receive the preventive services and medical care they need to achieve and maintain their best health. Just twenty years ago, 16 percent of children in North Carolina were uninsured. Fast forward to 2015 and the rate of uninsured children has hit record lows of 4 percent in North Carolina and 5 percent nationally. This is a direct result of expanded Medicaid coverage, NC Health Choice (North Carolina’s version of the State Children’s Health Insurance Program), and the passage of the Affordable Care Act.

As federal lawmakers and the President-elect consider changes to these programs, they must ensure that we don’t move backwards from these high-water marks.

Below is a rundown of potential and/or likely changes and what they could mean for children and families in North Carolina.


Medicaid is the backbone health insurance program for North Carolina’s children—1.3 million North Carolina children are covered through Medicaid (which is over one half of North Carolina’s child population), and the majority of people covered by Medicaid in North Carolina are children. Nationwide, 35 million children are insured by Medicaid.

Many Congressional Republicans, including House Speaker Paul Ryan, have long sought to remake our Medicaid program, either by block-granting Medicaid or by implementing per capita spending limits. According to Joan Alker at the Georgetown Center for Children and Families, both options could mean drastic reductions in the number of children who could be covered and in the services children need to stay healthy.

In either scenario, two primary (and related) changes would occur that would greatly reduce the availability and quality of health coverage for children:

  • Block-granting Medicaid or implementing per capita spending limits would result in a massive loss of federal funding, which the state currently relies on to fund children’s health coverage.
  • The federal laws requiring North Carolina to meet minimum standards for the state Medicaid program would be loosened, allowing state officials to reduce eligibility and service options for children to offset the loss of federal dollars.

The State Children’s Health Insurance Program

Currently, NC Health Choice, North Carolina’s SCHIP program, insures about 78,000 low-income children statewide who don’t qualify for Medicaid. Federal funding for SCHIP will expire after 2017, so Congress and President-elect Trump must take action next year to preserve the program.

Even if funding is extended, lawmakers could use this opportunity to reduce federal funding for states and make harmful policy changes to the program that could affect eligibility and service availability. If Congress and President-elect Trump choose to defund SCHIP, then the onus will be on state officials, and state dollars, to preserve health insurance for these 78,000 children.

The Affordable Care Act

The Affordable Care Act (ACA) improves the health of children and families by strengthening access to preventive services, protecting children with preexisting conditions, and expanding dependent coverage for children up to age 26. The ACA also provides millions of adults (including parents) with health coverage, and research shows that when parents are able to get affordable health coverage their children are much more likely to be signed up for affordable health coverage, as well.

President-elect Trump and congressional leadership have vowed to “repeal and replace” the ACA, and we expect some version of “repeal and replace” to make its way through Congress. What we don’t know is exactly what Congress and President-elect Trump will replace the ACA with.

Given the range of possibilities, it’s difficult to project what the direct implications for children’s coverage would be, but it’s likely that any rollback would result in fewer affordable insurance options for parents and future parents, which is critical for the health of children.

Over the past several years, one of NC Child’s priorities has been to persuade North Carolina lawmakers to utilize a provision of the ACA to draw down federal dollars to provide hundreds of thousands of adults with health insurance, including parents and women of child-bearing age. It’s unclear whether or not these federal dollars will continue to be available to extend coverage, and such uncertainty will not help persuade North Carolina lawmakers to take action on this issue.

What now?

None of these changes are written in stone and congressional leadership is showing early signs of disagreement on how to move forward, which could slow the progress of cuts and changes. NC Child will work closely with our national partners to monitor these discussions in Congress and we hope that you’ll be ready to join us in speaking up for children’s health when the time comes.

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