Editor’s note: This commentary is by Dr. Jill Rinehart, of South Burlington, who is a full-time pediatrician and managing partner of the independent practice, Hagan, Rinehart & Connolly Pediatricians, PLLC. She is the president of the Vermont Chapter of the American Academy of Pediatrics and Clinical Associate Professor of Pediatrics at the Robert Larner, M.D. College of Medicine at the University of Vermont.
[A]s a Burlington pediatrician, I see the importance of ensuring access to affordable, comprehensive health care coverage for children and families on a daily basis. Despite the frantic pace of our work to serve children, I feel compelled today to pause and applaud the demise of the American Health Care Act (AHCA), refute the rhetoric of an anti-health care administration and take a thoughtful look at what Obamacare has done and will continue to do for our nation’s health and future well-being.
As an independent practice owner I also recognize the challenges that rising health care costs place on my patients, employees and small business. Woven into Obamacare are parameters that allow for increased access to health insurance while simultaneously providing strategies to contain rising insurance costs. The harsh reality of the AHCA is that 35 million children, including 60,000 children in Vermont alone, could have lost access to health insurance altogether. Without Medicaid health care would be lost for those who need it most. For this reason, over 50 professional organizations, including the American Academy of Pediatrics, representing over 500,000 physicians, opposed the AHCA.
Dismantling Medicaid was never part of the pre-election narrative surrounding Obamacare. Really, it wasn’t — and for good reason: Medicaid is a highly functioning program that along with the Children’s Health Insurance Program (CHIP) and Obamacare has enabled 95 percent of all children to be covered nationally. Children like my patient, “Addie,” a 7-year-old with moderate persistent asthma (the most common chronic disease of childhood) whose single, working mother required orthopedic surgery, subsequently lost her job due to prolonged disability, and along with her job, her employer-sponsored insurance. Without Medicaid, Addie could not have afforded her costly asthma controller medications and could easily have landed in the hospital with an asthma exacerbation. Most children on Medicaid are part of working families such as Addie’s, and Medicaid “catches” families in times of economic crisis.
Forty percent of the entire Medicaid population are children, but they only account for 20 percent of the total costs of Medicaid.
Whether it’s responding to an adolescent found to have depression at her annual 14-year-old well visit, or screening a 1-year-old for lead toxicity — primary care is truly warding off costly health care conditions. Pediatricians identify illness and developmental concerns early, counsel and connect children and families to services that keep them safe, combat adversity and support their existing strengths as parents and individuals. This is an efficient, effective and evidence-based use of health care dollars.
Forty percent of the entire Medicaid population are children, but they only account for 20 percent of the total costs of Medicaid. We know that when children have access to Medicaid they miss fewer days from school due to illness or injury, they do better in school while they are there, they are more likely to finish high school, go to college, grow up to be healthy adults, earn higher wages —and even pay more in taxes as adults. Dollar for dollar, children are the “best deal” for health insurance in the short term with the most significant health promotion benefits in the long term. Simply put, it is bad business to dismantle Medicaid coverage and should have no part in this administration’s revision of Obamacare.
Vermont is a stand-out state for child health in large part because 99 percent of our state’s children and adolescents have access to health insurance. Any proposal that cuts enrollment in the Medicaid program means less coverage for those in our state who truly need it most: children living with medical complexity, chronic illness, intellectual disability and poverty. In Vermont specifically, Medicaid and Dr. Dynasaur (CHIP) cover 100 percent of children in foster care, 61 percent of children with disabilities, and 53 percent of infants, toddlers and preschoolers during the early years that are key to their future development and school readiness.
Rejecting the AHCA was an important step in the fight to maintain health care access for children and their families but, we must remain vigilant and ensure continued access to care with any future proposed changes to health care. Any action that reduces access to primary care, lifts insurance company regulations, increases the number of uninsured, or decreases funding for Medicaid will be detrimental to children’s health – both here in Vermont and nationwide – and result in less care for those, like Addie, who need it most.
Resources:
http://ccf.georgetown.edu/2017/02/06/snapshot-sources/
www.aap.org/en-us/Documents/ccs_factsheet_vermont.pdf
https://onecarevt.org/docs/toolkit/
