Martha Garcia, a Phoenix resident, finds comfort in knowing that her 10-year-old daughter and 9-year-old son have health insurance. She recently took them for vision, hearing, and dental screenings – things she wouldn't have been able to afford without health insurance.
"I can take my children to see a doctor whenever it's necessary, because they have health insurance," Garcia told New Times. "That gives me a sense of security."
Garcia's children recently acquired coverage through the Arizona Health Care Cost Containment System, or AHCCCS, a program for low-income families and the state's version of the federal Medicaid program. An estimated 1.9 million individuals have health insurance through AHCCCS.
An additional 30,000 children qualify for KidsCare, Arizona's version of the federal Children's Health Insurance Program, or CHIP, for children whose parents make too much money to qualify for AHCCCS but too little to afford health insurance on their own. KidsCare was reinstated in 2016 after a six-year freeze.
But child advocates worry that the progress Arizona has made to provide health insurance to children from low-income families could be undone when President-elect Donald Trump takes office. Trump has promised to repeal and replace the Affordable Care Act, which could affect federal funding for AHCCCS and KidsCare.
Currently, the federal government pays states for a percentage of Medicaid and CHIP expenditures based on a formula that takes into account several factors, including enrollment and per capita income. In Arizona, the federal government pays for 69.24 percent of AHCCCS expenditures and 100 percent for KidsCare.
Rather than using the current formula, Trump is proposing to give states a lump sum of money, known as a block grant, and allow them to administer it. According to his transition team, Trump wants to enable states "to experiment with innovative methods to deliver healthcare to our low-income citizens."
Child advocates in Arizona worry that could mean cuts to Medicaid and CHIP, and therefore, less federal funding for AHCCCS and KidsCare.
"Whether or not a block grant is a good idea depends on what actions states take and how much money is awarded to states," said Marcus Johnson, director of state health policy and advocacy for Vitalyst Health Foundation. "The risk is that if there isn't enough funding, then certain services will need to be cut."
Johnson added that federal funding cuts could deal a major blow to the work Arizona has put in to improve AHCCCS, which he said is recognized as one of the most efficient Medicaid programs in the nation. Advocates also worked hard to reinstate KidsCare this year, Johnson noted, ending Arizona's status of being the only state without an active version of the CHIP program.
"Potentially all of that work could be undone," Johnson said. "It could be supplanted with something completely different that may not give us as much funding as we have right now and may not allow us to have the same impact that we're having right now."
Advocates also worry about what could happen to Medicaid expansion once Trump takes office. Under the Affordable Care Act, Medicaid expanded its eligibility requirements to benefit people making less than 138 percent of the federal poverty level. That allowed about 44,000 more Arizonans to get health insurance.
Federal data shows the uninsured rate in Arizona has dropped by 36 percent since the Affordable Care Act was enacted in 2010. Though the rate of children who don't have health insurance in Arizona has fallen, it remained one of the highest in the nation, at 8.3 percent in 2015, according to a report by Georgetown University's Center for Children and Families.
Siman Qaasim, director of health policy for the Children's Action Alliance, worries that cuts in federal funding to AHCCCS and KidsCare could lead to more children being left without health insurance, which she said could have grave consequences. She noted that lack of health insurance can affect a child's ability to focus and learn in school.
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"Children who go to school with toothaches because their families can't afford to take them to see a doctor are going to have a hard time paying attention in school," Qaasim said. "That's going to impact their grades."
Johnson echoed that sentiment, saying children's ability to be healthy is "a fundamental building block to being able to be successful and to be able to learn and be prepared for school."
Johnson said that it's important for families to understand that no changes have been made to existing health-insurance programs, and that any changes made under the Trump administration could take years to implement. He said families can visit www.coveraz.org for a list of events that offer in-person assistance for those who need help signing up for health insurance.
"These resources are here, and people should be taking advantage of them as much as possible," he said.