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Kids, Coverage Challenges, and Quality Care

This morning, I watched an Urban Institute webcast called “Kids, Coverage Challenges, and Quality Care.” Panelists addressed pending issues and concerns with expanding coverage under ACA. It’s interesting to note that according to this study, 9 out of 10 metro areas with the highest populations of children are in California and Texas.

Stan Dorn, senior policy fellow at the Health Policy Center, outlined some of the concerns we foresee moving forward in expanding coverage including, but not limited to, the following.

  • States might be more worried about sustaining coverage for their current eligible population, for which existing FMAPs remain (between 50%-74.3%, according to KFF, in contrast to the 100% FMAP for newly eligibles for the first three years of coverage under ACA starting in 2014). Does this mean states will set up additional obstacles to enrollment? (Note: California’s current FMAP ranks among the lowest in the country at 50%.)
  • Families will have to pay money back to the IRS if they received too much in subsidies through the Exchange (if their income varied throughout the year, for example). Will families be disincentivized to purchase coverage in the Exchange if they risk owing money at the end of the year?
  • Although better than the status quo, monthly premiums through the Exchange, even after subsidies, will still be relatively high ($50, $100, etc) for low-income adults. Will this be unaffordable?
  • Provider participation for Medicaid is already very low. How will the coverage expansion impact access to care for currently eligible and newly eligible populations?