The Republican members of the Senate are currently debating behind closed doors their version of a health care bill to fulfill their campaign promises to reverse the ACA, or Obamacare. There is no involvement of the public, health care experts or health care providers in this process, so it is unclear what may emerge. As pediatricians practicing in Tucson we are concerned that the Senate may follow a similar path as the House version, or the AHCA (American Health Care Act). We are concerned because many of the provisions of the House bill will have a devastating effect on childrens’ access to affordable, quality care.

Currently, the rate of children’s health coverage in our country is at a historic high of 95 percent; the American Health Care Act would not only halt this progress, it would tear it down. The AHCA fundamentally changes the way the Medicaid program has functioned for the last 52 years. Those who will suffer the most are those who need health care the most, including the 37 million children who rely on Medicaid. In Arizona, Medicaid covers 636,000 children and they would be at risk of losing coverage under a block grant or per capita approach to funding. Though Medicaid is an entitlement program, it is also an empowerment program. Medicaid allows families to hold down jobs while caring for ill children. It allows pregnant women to access vital services to ensure mothers and babies stay healthy, and it provides critical supports for people with disabilities so they can live independently. The AHCA eliminates the Medicaid expansion, a vital safety net that has allowed many parents and other family members to access affordable coverage for the first time. Research shows that when parents have health care coverage, they are more likely to go to the doctor, miss less work, and are better able to care for their children. For example, Medicaid covers maternal depression screening and treatment, which has a direct impact on the health of the mother’s infant. Children are also more likely to be insured when their parents are insured.

The AHCA also allows insurance companies to once again go back to denying affordable coverage to those with pre-existing conditions. The bill allows insurers to put annual and lifetime limits on coverage, meaning that a premature baby on private insurance could exceed her lifetime limit on coverage before she even leaves the hospital. The American Health Care Act is bad policy for children and dangerous policy for our country. Children are not little adults. They need pediatric-specific health care services. Current law requires that health plans cover “pediatric services, including oral and vision care.” The AHCA would allow states to eliminate these essential health benefits. The law also requires that children receive other important “essential health benefits” including mental health care, newborn care, emergency care, and prescription drugs. Children with disabilities and other special health care needs receive habilitative care and chronic disease management.

The AHCA would also make coverage less affordable. The bill reduces tax credits and eliminates subsidies to help families afford insurance that meets their needs. For all of these reasons, we urge all constituents to call or write their Senators and make them aware of the importance of improving on the ACA, not destroying it.

Eve Shapiro has been a pediatrician in Tucson for more than 25 years and has been actively involved in efforts to improve health care access for children. Contact her at