Medicaid for all ... children? Pennsylvania’s Sen. Bob Casey wants to make that a reality

Every child born in America would be automatically enrolled in Medicaid, the publicly funded health program for low-income families, under a bill introduced in the U.S. Senate.

Children are currently eligible for Medicaid if their family’s income is within 133% of the federal poverty rate, or about $39,900 a year for a family of four in 2023. Families that earn too much to qualify for Medicaid can get low-cost coverage for their children through the Children’s Health Insurance Plan (CHIP).

Even with those options, many families struggle to afford health insurance and about 4% of children are uninsured, according to the U.S. Department of Health and Human Services.

The new legislation, introduced by Pennsylvania Democrat Sen. Bob Casey last month, aims to improve access and affordability. All children would be enrolled in Medicaid at birth, regardless of their family’s income. They would remain covered until their 19th birthday without the need to reenroll annually, as is typically required to maintain Medicaid coverage.

Parents could opt out of Medicaid in favor of private insurance or CHIP.

“Too many of our kids are struggling to stay healthy because their families can’t afford the care they need,” Casey, a Democrat from Pennsylvania who is currently running for reelection, said in a statement.

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In a divided Congress, with a looming government funding fight, the chances of such a large expansion of Medicaid seems unlikely. Casey’s office hopes the proposal will draw attention to the need for more stable health coverage for children.

Millions of people — including many children — have lost Medicaid coverage in recent months as states begin reviewing everyone who enrolled since 2020. A total of 15 million people are expected to lose Medicaid or CHIP, either because their income is too high and they’re no longer eligible or for procedural reasons, such as failing to complete needed paperwork.

States were required to suspend Medicaid reenrollment during the COVID-19 pandemic and resumed annual reenrollment in the spring.

» READ MORE: Thousands have lost Medicaid as post-pandemic renewals begin in Pa., N.J.

Nearly 185,000 Pennsylvania residents have lost Medicaid coverage as of Sep. 18, according to data from the Kaiser Family Foundation. About half of those lost care because of a procedural reason and not because they were determined to be ineligible. It’s unclear how many of those people may still be eligible for coverage.

Children accounted for 25% of those who lost coverage in Pennsylvania.

Medicaid is run by states and jointly paid for by states and the federal government. Casey’s proposal calls for the federal government to pay states back for 100% of the cost of the coverage of children. But his officedid not have a cost estimate at this time.

Some see flaws in the proposal.

Casey’s bill doesn’t ensure high-quality care or access, said Elizabeth Stelle, director of policy analysis at the Commonwealth Foundation, a Harrisburg-based conservative think tank. For example, studies showed that people with Medicaid have a harder time accessing specialists than those with private insurance.

“An insurance card doesn’t guarantee you access,” Stelle said.

Stelle said she is also concerned about the cost of the expansion to cover all children. She questioned whether taxpayers should pay for the health care of children from high-income families.

“It’s what going to be needed if there is going to be transformative change in the health-care space for kids,” said Becky Ludwick, vice president of public policy at the Pa. Partnership for Children, a Harrisburg-based child advocacy nonprofit.

The proposal’s requirement that children maintain coverage without renewal until age 19 will significantly reduce the number of children who are uninsured or who experience gaps in coverage because their family didn’t renew, she said.

Some states, such as Oregon, have received permission from the federal government to enroll children for the first six years of their lives. But no state comes close to covering kids through their 19th birthday, as Casey is proposing.

“There’s a lot of benefits that come with having this continuous coverage” Ludwick said. “We would not see children unnecessarily falling out of coverage when they don’t need to.”