• Article
  • November 15, 2017

The Word on the Hill: The Health Care Debate and its Effect on Kids

Public policy decisions made in Washington, D.C. can affect the everyday operations of children's hospitals. Here's what went on so far in 2017 in the nation's capital, what may happen in the near future, and potential ramifications for children's hospitals and the kids they serve.

Though far removed from any patient's bedside, public policy decisions made in Washington, D.C., can have effects on the everyday operations of children's hospitals. In a recent webinar, "Looking Back, Looking Ahead: The Health Care Debate and its Effect on Kids," Children's Hospital Association (CHA) public policy experts Jim Kaufman and John Knapp summarized the first nine months of the Trump administration and 115th Congress, detailed what that action meant for children, and looked ahead to the coming months.

Medicaid and ACA repeal attempts

Kaufman says one overarching problem for lawmakers in Washington, D.C., is that the deficit is expected to grow soon. According to the nonpartisan Congressional Budget Office, the U.S. government will experience trillion dollar shortfalls in the not-too-distant future. The three biggest drivers in the federal budget are Social Security, Medicare and Medicaid.

With few policymakers talking about major changes to Medicare or Social Security, Medicaid became a target in 2017. With more than 30 million kids covered by Medicaid, any attempt to change or cut Medicaid could have huge effects on kids and the hospitals that serve them.

In early 2017, efforts to repeal and replace the Affordable Care Act (ACA) quickly became tied to efforts to dramatically alter Medicaid. Knapp says the slew of bills put forth by the House and Senate tied ACA repeal efforts to Medicaid cuts. A study of one of these bills projected it would amount to a $40 billion cut for kids over 10 years, and subsequent legislative proposals were even more dire.

The window to pass this kind of legislation using Senate rules that allow a simple majority to approve a bill has closed for now, Knapp says. However, similar efforts could easily come back as part of FY 2018 or 2019 budgets.


Funding for the Children's Health Insurance Program (CHIP) expired on Oct. 1, and Knapp says children's hospitals have been working to make sure Congress acts soon to extend the program. States aren't running out of money immediately, which means children aren't necessarily going to lose services. But with kids not at immediate risk, Congress has not acted with urgency to extend this program that covers more than 6 million kids.

The House and Senate have considered a five-year extension and continuation of critical program elements and funding. While the House passed a CHIP bill in early November, the Senate has failed to act. Decisions around how to pay for a CHIP extension have meant that things are stalled for now, and Knapp says it's likely CHIP will get wrapped into a larger package at the end of the year.


Children's Hospital Graduate Medical Education (CHGME) helps train the next generation of pediatric providers. Knapp says the House has recommended full funding of $300 million for CHGME in FY 2018, and the Senate recommended an increase to $305 million. There will be a lot of conversation on CHGME in the coming months, Knapp says, since Congress will not only need to make funding decisions, but will also need to reauthorize CHGME by October 2018.

ACE Kids and other issues 

Knapp and Kaufman also described the current and likely future landscape for other issues critical to children's hospitals during the webinar. The Advancing Care of Exceptional (ACE) Kids Act remains under consideration in Congress, and changes are expected soon to leadership at the Health and Human Services Department that oversees Medicaid and CHIP.

Get more updates

To learn more about children's hospitals' progress on Capitol Hill, lessons learned from 2017, and next steps, listen to the webinar.

Send questions or comments to magazine@childrenshospitals.org.