To calculate how many more children will get health insurance under the ACA, the authors examined 2009 data from the Census Bureau's Survey of Income and Program Participation. They applied final and proposed federal eligibility rules for Medicaid, CHIP, and the premium tax credit to survey data representing U.S. children 18 years of age and younger in January 2009.
Although they found that many more children likely will be insured once the law goes into full effect, the authors cautioned that "Under [the ACA], CHIP is not funded beyond 2015, and states may opt to reduce CHIP eligibility or eliminate programs in fiscal year 2020. Without CHIP, more children could become uninsured."
In addition, "uncertainty exists regarding whether some low-income children will remain ineligible for any of these types of assistance, whether changes in eligibility caused by shifting family circumstances or differences in eligibility between children and their parents could deter enrollment, and whether states will be able to fully implement key provisions of [the ACA] by 2014," when the law is fully in effect, they noted.
Some groups are concerned about the federal government's proposed rule for determining who is eligible for the premium tax credit toward purchasing private health insurance in the insurance exchanges, the GAO said.
The proposed rule denies tax credits to families that have access to "affordable" employer-sponsored health insurance. But the rule defines affordability based on the cost of insuring only an employee, not on the cost of a family policy.
Because the cost of a family policy is higher, "some employees would not be able to afford the higher premiums to insure their family members, who therefore could remain uninsured," the report noted.
The agency recommended that the government "consider the impact of the proposed standard for determining affordability of employer-sponsored insurance on children and other family members who are eligible to enroll, and whether it would be consistent with the goals of [the ACA] to adopt an alternative approach that would consider the cost of insuring eligible family members."