Proceed cautiously with Medicaid reforms to protect gains made in caring for our youth
As the discussion about healthcare access and coverage in our nation goes forward, we all must be committed to ensuring that our nation’s most precious resource—children and adolescents—are prioritized.
In making choices about the allocation of healthcare funding, it is critical that we don’t lose sight of our children and youth. While they represent a small share of the nation’s healthcare expenditures relative to adults, access to appropriate services is critical for their development and for the future of our country.
There is much to consider going forward, about how proposals for changes to coverage, access and financing will impact different segments of the population—children, families, the disabled and the elderly. We have the opportunity to advance the future of children’s health and well-being by keeping programs such as Medicaid and the Children’s Health Insurance Program intact as critical sources of care and access.
The Medicaid program, enacted in 1965 under Title XIX of the Social Security Act, and CHIP, enacted in 1997, changed the trajectory of healthcare for children. These programs provide access to care for more than 45 million children and adolescents across our country. From urban centers to rural areas, the rate of uninsured children across our states dramatically decreased, leading to improved health outcomes.
What are these essential services for children that make a difference? Important benefits such as physical and mental health services, the Early Prevention, Screening, Diagnosis and Treatment Program, dental and vision care, rehabilitation services and special equipment have been key.
Children with access to a regular source for care, including well-child visits and access to specialists, have better health and better school performance. Regular visits help parents and children develop a strong and trusting relationship with their pediatric medical providers and have the potential to identify issues before they become more serious problems, including delays in development, behavioral issues or physical health challenges.
For many children, access to primary, specialty and subspecialty care and lifesaving and life-enhancing treatment at children’s hospitals across our country makes a difference in their everyday lives. For some, it is a matter of life or death.
At Children’s Hospital Los Angeles, we treat many children with complex and special needs. Our patients are a unique population whose needs change across the developmental span. If they don’t have access to important benefits and specialized services through Medicaid, their ability to live a full life in the community will be in jeopardy.
As I talk with patient families, I am in awe of how they approach the challenges of nurturing and sustaining their children and often hear firsthand how deeply they count on access to specialized healthcare—care that is supported by these government programs that were launched to provide access to healthcare for the most vulnerable among us: our children.
Advances in treatments such as precision medicine, emerging technologies and new drugs offer the potential to change the way healthcare is provided for infants, children and adolescents—in fact, the entire patient population—and offer the promise of greatly improved health outcomes. Changes to the financing of Medicaid and CHIP being discussed at the federal level, such as block grants or percapita allotments to states, should be carefully considered. If these measures have the effect of reducing funding or reducing essential services and benefits for children, we stand to lose the gains that have been made in our ability to improve population health, and we put the future of these children and our very country at risk.
As the nation considers changes to the system of healthcare policy and reimbursement, we need to remember that any measures that impose sharp cuts to coverage or benefits have the potential to hurt our most vulnerable populations. As Medicaid, CHIP and the Affordable Care Act are assessed for further reform or even repeal, let’s work together carefully to identify the opportunities that can help strengthen our nation—and preserve the programs that benefit children, families and communities. ●
Paul S. Viviano is president and CEO of Children’s Hospital Los Angeles.