Pro­ceed cau­tiously with Med­i­caid re­forms to pro­tect gains made in car­ing for our youth

Modern Healthcare - - COMMENT - By Paul S. Vi­viano

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.

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