The prospects of passing the American Health Care Act dimmed on Friday, and that’s a relief.
The bill takes an unwise gamble that could inadvertently be devastating to children’s health, nationwide and here in Spokane. Rather than making a smart long-term investment in children’s health care, the AHCA focuses on making cuts now, meaning many children won’t get the health care they need. That hand plays out as fewer preventative immunizations, delayed health care, expensive emergency room visits, and eventually, untreated chronic diseases that become exceedingly expensive adult medical conditions.
Research shows that providing Medicaid benefits for children is a smart investment for the country. Currently nearly half of our nation’s children are provided health care through Medicaid (30 million) and Children’s Health Insurance Program (6 million). Children’s health care is already funded at the lowest level per patient. Despite the fact that nearly 50 percent of people covered through Medicaid are less than 18 years old, only 20 percent of Medicaid spending is on this population. These figures are mirrored in the state of Washington, where children represent 45 percent of Medicaid enrollees but only 18 percent of Medicaid expenditures. Therefore, the $888 billion in federal funding cuts would disproportionately target children.
As a pediatrician, I am deeply concerned that the changes proposed are “penny wise, pound foolish.”
Not only do our children deserve the best coverage, but untreated pediatric illnesses grow into expensive adult medical conditions. In short, wisely cared for children create huge medical saving in the future.
In the state of Washington, currently 1 out of 2 children are covered by Medicaid. With the 2008 Affordable Care Act expansion, 100,000 more children received medical coverage, achieving (the previously thought unimaginable) goal of nearly all children in Washington being insured. Currently, in Spokane County, we have more than 66,000 children insured by Medicaid, known as Apple Health for Kids.
Medicaid has historically enjoyed broad bipartisan support as a cost-effective safety net to keep children and families healthy. The proposed AHCA would cap the federal Medicaid support each state would receive in 2020, using a formula that would not necessarily give equal support to each state. This change transfers the financial burden and risk of pediatric health care to the states, essentially creating an unfunded mandate. Maybe not intentionally, but at risk are preventative immunization programs; coverage of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT), an essential health benefit requirement (endorsed by the American Academy of Pediatrics); and expanded coverage for children with complex illnesses.
Children without adequate medical care, such as incomplete immunizations, can develop diseases we rarely think of today, such as polio and measles and their associated lifelong complications. Additionally, children with untreated chronic diseases, such as cystic fibrosis, will have significantly more hospitalized days and reduced life span into their teens and twenties.
What we are truly gambling with is the potential of our children living a healthy, productive life, long after they are no longer children.
We must not allow the health of our children be buried within the political and financial debates of numbers. Representatives are hearing from parents and families all over the state that they want healthy, safe families and long-term economic stability. Crafting a successful health care law requires thoughtful consideration and a weighing of all the risks and benefits. Demanding a quick change does not protect Americans at any level. I urge our members of Congress to heed what constituents are saying – oppose any proposed legislation that would reduce Medicaid coverage for children and don’t gamble with the health of our children and their futures.
Dr. Mike Barsotti is a pediatrician and chief medical officer for Sacred Heart Children’s Hospital.
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