U.S. Sen. Lisa Murkowski took a brave stand when she voted against the health care bill earlier this summer that would harm Alaskans by slashing the Affordable Care Act and Medicaid. Sadly, the attack on health care has come again in the form of the Graham-Cassidy bill now in the Senate — and one of many groups that would be disproportionately impacted by the bill are kids in foster care. Graham-Cassidy cuts Medicaid through block grants and per capita caps, and kids in the child welfare system stand to be hardest hit. We are sending this letter on behalf of a coalition of organizations dedicated to youth in the foster care system, including Children’s Defense Fund and First Focus Campaign for Children
What does a per capita cap for Medicaid spending mean? Caps force states to ration care. If the need in Alaska exceeds the cap, the cost will fall on the state or locality — the majority of which, including Alaska, will not have adequate funds. This will stall any efforts to expand the health insurance safety net. What this means in practice is impossible choices will need to be made — will Alaska provide care for a senior? A medically fragile kid in foster care? Parents of a child who are struggling with mental health and drug addiction, for whom access to care may be the difference between keeping their family together or having more youth enter the child welfare system? These are decisions the state should never have to make.
Because youth and families involved with the child welfare system often have high health care needs, these caps will put a strain on the ability of systems to serve youth and families. As a result, kids may enter foster care and costly institutions simply because parents cannot afford their care. Child welfare agencies, which are required to provide for the needs of youth in their care, will likely be overburdened and have to foot the bill for health care needs.
Right now, Alaska has a record high number of youth in foster care — 3,099 as of August 2017. Sen. Murkowski has long been a champion for these youth. We urge her to be such a champion now and to vote against this devastating bill. This bill has the same provisions as the previous similar efforts where Medicaid is concerned: block grants and per capita spending. For the same reasons, this bill must be defeated.
The bill won’t just harm kids already in foster care. Loss of coverage to poor families will mean an increase in the numbers of youth coming into the child welfare system and a decrease in those able to return home. Medicaid for adults and expansion of coverage to poor adults has greatly improved both the capacity of families to care for their kids and the capacity of child welfare agencies to serve families. The need for addiction and mental health services for these parents is growing in many states, as the opioid crisis continues. Depriving adults of care has catastrophic consequences, often felt most painfully by their children. Dismantling Medicaid will drive more youth into foster care and will not create a savings in improved health outcomes.
Accessible, quality health care serves as a foundation for many of our essential social service systems. Graham-Cassidy negatively impacts them all — child welfare, juvenile justice, special education, disability services, homelessness prevention, among others.
This bill will have harmful human costs that we all must guard against. Sen. Murkowski, please put people first once again and vote against this bill. It is our duty to stand up for youth in foster care and their families.
• Susan V. Mangold is the executive director of the Juvenile Law Center. Amanda Metivier is the founder and board member of Facing Foster Care Alaska.