As a pediatrician, I am in the business of caring about kids. While most of my time is spent in direct clinical care, I am also interested in legislative advocacy. This week, I even had the opportunity to testify in a committee hearing at the Statehouse on behalf of paid family leave. Did you know that the US is the only developed nation without a paid family leave program? We have so much work to do to support families and children in our country, and I love being a voice for positive change when I am able to step away from my clinical rotations.
And that brings me to healthcare policy. I wanted to write out a quick primer on what I think is important to know about the American Health Care Act and the threat it poses to healthcare for kids in America. I had the chance to learn more about the details of this through talking with knowledgable buddies at work and via the Indiana chapter of the American Academy of Pediatrics this week, and what I learned is that this bill is scary stuff for kids! If you’d like to take my word for it, you can go ahead and scroll down for links to call your representatives. If you want the deets… read on.
To understand why the AHCA is scary stuff, you need to know about 1. why healthcare is important for kids and 2. how healthcare is financed for kids.
1. Why is healthcare important for kids?
Preventative care, developmental screenings, and vaccination in childhood set the stage for growing into a healthy adult! So much of my job is helping families know how to raise healthy kids with counseling at each visit ranging from diet and exercise advice, to carseat safety, to smoking cessation counseling for parents. The early intervention facilitate through frequent pediatrician visits in early childhood can address lots of issues in their infancy (speech delay, physical delay, learning disabilities… the list goes on and on) and reduce long-term healthcare costs by getting something taken care of before it escalates into a bigger problem. Plus – kids have medical problems, too! Asthma, diabetes, ADHD, spina bifida, genetic syndromes, mental health issues… kids need access to care just as much as adults do.
2. How is healthcare financed for kids?
Kids aren’t in charge of being able to access insurance coverage and care. They aren’t in charge of whether their parents work for an employer who provides insurance coverage. They aren’t in charge of whether their parents purchase insurance through the Healthcare Marketplace. I believe, fiercely, that healthcare is a basic human right – and we must have a safety net for children who are not privately insured (or insured through the Healthcare Marketplace). So what does that safety net look like in Indiana?
Right now, we are doing a great job of keeping kids insured! 95% of American kids (and 93% of Hoosier kids) have insurance. 31% of those kids are insured by Medicaid and Hoosier Healthwise (CHIP). To put that into perspective, that means that 779,000 children in Indiana rely on Medicaid and Hoosier Healthwise for coverage. That is a lot of kids!!
If you aren’t familiar with these programs, here is some basic info:
– Medicaid provides guaranteed coverage, pediatrician-recommended services, and cost-sharing protections. Through it’s definitive standard of care for children (Early and Periodic Screening, Diagnostic and Treatment (EPSDT)), kids receive comprehensive services. Medicaid is a federal-state partnership, meaning that funds are matched by the federal government. These funds are flexible, which is important given the flux of healthcare needs over time as varying population needs arise. Each state has the flexibility to design its program within federal guidelines.
– The Children’s Health Insurance Program, or CHIP, is a program that builds on Medicaid to cover children who lack affordable access to care but do not meet criteria for Medicaid. Again, each state designs a CHIP program under federal guidelines. The Indiana CHIP program is known as Hoosier Healthwise. CHIP funding expires a the end of the fiscal year 2017 and must be renewed so that this program can continue.
It’s important to know that Medicaid works and that in general, pediatricians like Medicaid! We like being able to provide appropriate services to our patients! Without Medicaid, it would be incredibly challenging to care for 31% of the kids in our state. It’s a relatively inexpensive program, with the average annual expenditure per child sitting at $3,3389/year. Think about your healthcare costs – that’s pretty good, right?
So – why am I blabbering on about all of this? The AHCA proposes changes to the way that Medicaid is funded. I like this explanation by the Kaiser Family Foundation:
“Throughout the Medicaid program’s history, Medicaid costs and risks have been shared by states and the federal government. The guarantee of federal Medicaid matching funds with no pre-set limit expands states’ capacity to provide health coverage for their residents and helps them manage increases in Medicaid costs that are fueled by health care cost inflation, the emergence of expensive new treatments and drugs, and the aging of the population. Because states share the costs of Medicaid, they have strong incentives to run efficient and effective programs, and state cost-cutting measures taken in hard economic times, including reductions in provider payment, have led to lean Medicaid operations. Beginning in FY 2020, the House bill would cap federal Medicaid funding per enrollee to achieve federal savings, shifting costs to states (Figure 1). According to the CBO, under the House bill, federal Medicaid spending would fall by $880 billion over the period 2017-2026. In 2026, federal spending for Medicaid would be about 25% lower than expected under current law, and 14 million fewer people would be covered by Medicaid than expected under current law.
The bill would give states some flexibility to reduce costs by repealing the requirement that states provide the federally-defined essential health benefits for Medicaid expansion adults. However, it would also reduce states’ flexibility to maintain Medicaid eligibility and coverage at current levels.”
(http://kff.org/medicaid/issue-brief/restructuring-medicaid-in-the-american-health-care-act-five-key-considerations/)
So – instead of knowing that funds would be matched – we would be operating under a system that left the deficit to the state. This money does not just magically appear, and fiscal juggling would have to occur at a state level. This is concerning, as cuts would likely need to happen somewhere, and the state budget has less of a buffer. Are we going to cut the kids? Those with disabilities? The elderly? Medicaid protects vulnerable populations. It is a big financial burden, yes. We need to work on that. But the AHCA proposals simply shift the burden in a dangerous way that puts our already vulnerable populations at risk. Try again, elected officials!! I will not support this bill.
Are you still with me? It’s time to take action.
- Find out who your elected officials are here: http://www.in.gov/sos/elections/2681.htm
- Call members of the House of Representatives (they are currently debating the bill).
Representative Todd Rokita: (202) 225-5037
Representative Susan Brooks: (202) 225-2276
Representative Peter Visclosky: (202) 225-2461
Representative Jackie Walorski: (202) 225-6798
Representative Jim Banks: (202) 225-4436
Representative Luke Messer: (202) 225-3021
Representative Andre Carson: (202) 225-4011
Representative Larry Bucshon: (202) 225-4636
Representative Trey Hollingsworth: (202) 225-5315
Don’t know what to say? The Indiana American Academy of Pediatrics suggests these awesome talking points. This is legit all you have to say!
If talking to a congressional office that opposed the AHCA:
- Thank you for speaking up against the AHCA. We are at a historic high for insurance coverage for children in Indiana – 93% – and the AHCA would take us backward. Please continue to oppose the AHCA.
If talking to a congressional office that supported the AHCA:
- Please help us preserve the gains in children’s health care coverage. Please reconsider moving forward with proposals that will move health coverage for children backward.
If talking to a congressional office whose position is unknown on the AHCA:
- Please help us preserve the gains in children’s health care coverage. We must ensure this coverage is comprehensive, affordable and accessible for children and families. I strongly urge you to oppose the AHCA, and to vote against it.
Ready, go! Together, we can help keep our kids covered.
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