How Medicaid Expansion Will Help Tennessee Children

In June 2012, the Supreme Court ruled that states could decide for themselves if they should expand Medicaid as part of the Affordable Care Act. 19 states, including Tennessee, have chosen not to expand Medicaid eligibility up to 138% of poverty. Because of the Supreme Court decision allowing states to choose, there has been a natural experiment comparing expansion and non-expansion states since the ACA became the law of the land in 2010.

But what does expanding coverage to working-class adults have to do with the health of children?

Currently in Tennessee, parents/caretakers below 100% of Federal Poverty Level (FPL) can get health insurance through TennCare until their child is 18.

As you can see from the chart above, not all parents are eligible for TennCare, even if their children are. In fact, as of 2016, 183,000 children in Tennessee (13%) have a parent without health insurance. Approximately 110,000 parents lack health insurance.

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This means there are parents in the coverage gap in Tennessee. 24,000 uninsured children are under 150% of poverty and stand to benefit from their parents having access to comprehensive insurance.

As we have written before, expansion has had positive economic impacts, including for individuals that receive care through Medicaid and for the states that expanded.  For example, Louisiana, an expansion state, has added 19,000 new jobs, saved $317 million and covered 470,000 more people since they expanded.

Some families are caring for children with complex healthcare needs and disabilities well after their 18^th birthday. Prior to the ACA, many people with disabilities were required to live in poverty to maintain their Medicaid eligibility. With Medicaid expansion, they can now enter the workforce, increase earnings, and maintain coverage.

There are many more positive effects of Medicaid expansion: Medicaid expansion states are less likely to have hospital closures; Medicaid expansion enrollees do better at work or in their job search; there is increased receipt of recommended pediatric preventive care for the children of Medicaid expansion adults; and uptick in enrollment of uninsured children.

Analysis shows that Tennessee would benefit from expanding Medicaid, including a decrease in out-of-pocket costs, a decrease in the number of uninsured and a decrease in uncompensated care costs.

Medicaid expansion has helped children who are eligible for Medicaid or CHIP finally get the coverage that they qualify for. Because of the ACA and more parents getting coverage, they also enrolled their children. Conversely, when steps are taken to limit coverage of parents, like Maine’s Medicaid cuts in 2012, child enrollment in their Medicaid program dropped 13% among the income level of the parents who were cut from the program. When parents don’t have insurance, children are less likely to get the care that they need.

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Kids do better when their parents are healthier. We already know this from research and practice. For example, poor parental health correlates with adverse childhood experiences (ACEs) and cost billions of dollars in care costs and lower productivity. Maternal depression is also a significant problem with many long-lasting negative impacts on children. When Oregon extended access to Medicaid to adults, including parents that had previously made too much to qualify for Medicaid but not enough to afford private insurance, rates of depression decreased by 30 percent because of new coverage.  Depression is correlated with poverty, and Medicaid is taking strides in addressing maternal depression.

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For the traditional Medicaid population (which is mostly children, some parents of minor children, the elderly and people with disabilities) like the one in Tennessee, Medicaid is a significant tool in reducing poverty and improving outcomes for lifelong success, particularly for children. Medicaid does not trap families in poverty; in fact, in fact, Medicaid helps low-income children escape poverty.

Medicaid is one of the most effective antipoverty programs in the United States, comparable to the combined effect of all social insurance programs and greater than the effects of non-health, means-tested benefits and refundable tax credits, like the Earned Income Tax Credit (EITC) and Supplemental Nutrition Assistance Program (SNAP) benefits. Medicaid has a larger effect on child poverty specifically than all non-health, means-tested benefits combined.

Even if a Medicaid beneficiary finds a job that has employer-sponsored insurance, Medicaid is still the best type of insurance for reducing poverty among beneficiaries.  This study showed that Medicaid reduced poverty by 17.1 percentage points for its beneficiaries, compared to 5 percentage points for employer-sponsored insurance and 6.6 percentage points for premium subsidies.

MORE: Medicaid Helps Lift Families Out of Poverty

Tennessee has still not expanded Medicaid eligibility, with cost being one of the concerns of opponents. However, the research is clear: adults who live in non-expansion states are significantly more likely to report an unmet need for health care due to cost and problems paying family medical bills.

Bankruptcy due to high medical bills is unfortunately too common in Tennessee. Since the ACA’s passage, low-income families struggling to pay medical debt decreased almost 30 percent.

Medicaid also limits high, out-of-pocket medical costs that can lead to significant medical debt. Research shows that families covered by Medicaid expansion saw a significant decrease in struggling to pay their medical bills. These limits are particularly helpful in rural areas, where parents of children with Medicaid or CHIP are twice as likely to report reasonable healthcare expenses than parents whose children are covered on private insurance. Freeing families from medical debt allows them to take care of other outstanding bills and debt and gives them financial peace of mind about taking care of their families.

Medicaid is primarily a children’s health insurance program. Keeping families healthy and protecting them from financial hardship, giving them peace of mind when it comes to health and finances. Let’s support parents and soon-to-be parents by giving them access to affordable health insurance, so that they can be at their healthiest before they have children, during their prenatal months and once they are raising their children. We will all be better for it.