Pediatrician Ryan Buchholz examines a patient at Unity Health Care’s Upper Cardozo Health Center in D.C. (Unity Health Care)

Lower-income children would have their federal health benefits cut sharply under President Trump’s proposed budget, which analysts say could reverse gains that have pushed uninsured rates for this vulnerable population below 5 percent.

The shift stems from a combination of factors, including a plan to reduce Medicaid by $1.4 trillion over the next decade and a roughly 20 percent decrease in funding for the Children’s Health Insurance Program (CHIP), along with proposed changes to eligibility requirements and the way federal matching funds are calculated.

Medicaid provided health benefits for 37.1 million children over the course of fiscal 2016, according to federal officials, while CHIP covered 8.9 million during that same period. Office of Management and Budget Director Mick Mulvaney said Tuesday that the administration was acting responsibly by curbing the growth of Medicaid. He did not address funding for CHIP, which covers children of the working poor.

“There are no Medicaid cuts in the terms of what ordinary human beings would refer to as a cut,” Mulvaney said. “We are not spending less money one year than we spent before.”

Several Republicans, including Senate Finance Committee Chairman Orrin G. Hatch (Utah) and House Appropriations Committee Chairman Harold Rogers (Ky.), quickly joined Democrats, medical experts and children’s advocates in pushing back. The overall budget, they said, would reduce coverage for children in families who make too much to qualify for Medicaid but not enough to afford comprehensive health plans.

What Trump’s budget cuts from the social safety net
In his 2018 budget proposal, Trump made many deep cuts to programs aimed at reducing poverty.

Hatch, who co-authored the CHIP-program legislation in 1997, said lawmakers were determined to preserve health insurance for such children. “Everybody wants to help children,” he said. “We all believe in that. I think that’s a natural bipartisan approach.”

Trump’s plan would cut CHIP spending by $5.8 billion between now and 2019, largely by eliminating the additional 23 percent federal match the Affordable Care Act gives states beyond their traditional Medicaid match. The government would also stop funding the program for children whose families earn above 250 percent of the federal poverty line — $61,500 for a family of four — affecting residents in 24 states and the District of Columbia.

In addition, states would be allowed to put more than 562,000 older children who were moved to their family’s Medicaid plans under the ACA back in separate state CHIP programs. Some states are likely to charge these children modest premiums, which could lead to a loss in coverage.

Joan Alker, executive director of Georgetown University’s Center for Children and Families, said Tuesday that Trump’s proposed budget “represents a very, very serious threat in the progress this country has made in covering children.”

“There’s no question we would make a U-turn on that progress,” Alker said. “It’s just a question on how sharp a U-turn would be.”

In some instances, a decline in federal matching funds could trigger an automatic stop in a state’s CHIP program. The number of children with coverage under Arizona’s CHIP program, called KidsCare, dropped from about 45,000 to less than 1,000 after the state suspended it in 2010. More than 8 percent of Arizona’s children were uninsured in 2015, compared with 4.8 percent nationwide.

(Reuters)

Arizona restarted KidsCare in September, and it now covers roughly 20,000 children there. But if its federal match drops under 100 percent, Arizona law requires state officials to freeze program enrollment.

“The combination of the CHIP and Medicaid cuts will be devastating,” Dana Wolfe Naimark, president and chief executive of the Children’s Action Alliance, said Tuesday.

Heidi Capriotti, spokeswoman for Arizona’s Medicaid agency, said in an email that state officials do not have a position on Trump’s policy proposals “and we will implement any changes accordingly.”

In D.C., where CHIP covers children in families earning up to 324 percent of the poverty level, the budget cuts also would translate into a loss of coverage.

Ryan Buchholz, a pediatrician at Unity Health Care who also serves as its medical director for quality improvement, said in an interview that more than 18,000 of the practice’s pediatric patients receive Medicaid coverage.

The loss of coverage would probably mean some children no longer coming for annual checkups — visits during which he has often diagnosed serious medical problems, Buchholz said. Six years ago, he saw a newborn who was vomiting repeatedly and realized that a narrowing in the baby’s stomach was preventing his mother’s milk from reaching his intestine. The child, who was covered by Medicaid, had surgery and remains healthy.

“Losing Medicaid, in his case, might have completely changed his life,” Buchholz said. “What does it say that we’re cutting off preventive care to kids?”

Kelsey Snell contributed to this report.