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Wednesday, July 17, 2019  Spokane, Washington  Est. May 19, 1883
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Opinion >  Guest Opinion

Dr. Mike Barsotti: AHCA a threat to Washington state’s children

By Dr. Mike Barsotti For The Spokesman-Review

As a pediatrician, I read U.S. Rep. Cathy McMorris Rodgers’ explanation (May 5 edition) about her support of the American Health Care Act with great interest. I applaud her for sharing her very personal story of raising a child with special needs. Her son, Cole, has Down syndrome. However, I am concerned that she does not recognize the grave threat the AHCA poses to Medicaid and to the 96,000 children in her district who are covered by it.

Medicaid was originally formed in 1965 to meet the unique needs of people with disabilities, including children. It’s important that we celebrate the successes this program has achieved. Medicaid was designed to catch pediatric problems early, giving children the best possible outcomes. I am proud of what Medicaid has done to improve the health of children in the U.S. and Washington state, providing access to early and cost-effective care, and ensuring that children get evidence-based pediatric care.

Rep. McMorris Rodgers acknowledges that safety nets are important and must be protected, yet under the AHCA funding for Medicaid would only be maintained until 2020, when massive cuts would kick in, putting the health of our most vulnerable at risk.

In Washington state, half of all children are covered by Medicaid. In Rep. McMorris Rodgers’ district, it’s 57 percent. The AHCA will give states a fixed amount to spend on Medicaid – either per person or via block grant – resulting in cuts of $880 billion over 10 years, according to the Congressional Budget Office. Approximately $100 billion of those cuts would be to children’s health.

Additionally, if your state has been diligent, creating an efficient Medicaid system, you would be funded at a lower rate, adding increased burden. Washington state has thoughtfully established a Medicaid program for children over decades, and today nearly every child in our state has health insurance. If states face cuts of this magnitude from the federal government, we do not know how we will be able to provide kids early and effective preventive care, let alone care for their special needs.

Medicaid funding is not my only concern. The current AHCA proposal would also eliminate the federal requirement that plans cover essential health benefits if states seek the waiver offered under the MacArthur amendment. Maternity coverage is at risk, increasing the chances that the pediatric special needs population will grow. For kids, vision and oral health care are among the current essential health benefits covered, along with preventive care like immunizations, obesity counseling and autism and developmental screening. These essential health benefits align with the recognized standard of quality pediatric preventive care and form the foundation for a lifetime of health and wellness.

The AHCA prohibits denying coverage to people with pre-existing conditions. Rep. McMorris Rodgers assures us that high-risk pools at the state level will provide coverage for those with pre-existing conditions.

At first blush, this appears reasonable; however, within the proposed program states could choose to let insurers charge more to insure sick people. Their compromise is an amendment to the AHCA, providing an additional $8 billion over five years, specifically to help those states seeking waivers subsidize those high-risk pools. However, the true impact of this additional funding would be inadequate, especially if many states choose to apply for waivers. In fact, according to research from Avalere Health, just 5 percent of Americans with pre-existing chronic conditions who currently have individual coverage (110,000 people) will benefit from funds written into the AHCA. How will we help the other 95 percent?

As is typical of the Affordable Care Act reform discussion, the effect on children is an afterthought, a mere footnote in the conversation. Rep. McMorris Rodgers has a personal stake in this discussion, but by supporting the AHCA, she is putting our children at risk.

Dr. Mike Barsotti is a pediatrician and chief medical officer for Sacred Heart Children’s Hospital.

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