Saving Medicaid means keeping Connecticut kids healthy, safe

As the U.S. Senate prepares to vote on its health care bill, it is time for us to break our silence and voice our unease.

We write as concerned pediatric residents and citizens. We write worried that our ability to provide comprehensive care for our patients will be severely limited if the Medicaid cuts currently under consideration become a reality.

We write for Juan, a 2-year-old who came to our clinic for his routine well-child visit. He left with not only a lead poisoning diagnosis, but also with an action plan and a treatment plan to address his needs.

We write because we worry that with any Medicaid funding cuts, screeners we use during primary care clinic visits will no longer be available – and that Juan may have slipped through the cracks.

Medicaid covers over 291,000 low-income families and children with special health care needs in Connecticut. It is a lifeline program and one that allows children to grow up healthy and educated. It levels the playing field, ensuring that the micro-preemie babies we care for in the neonatal ICU have appropriate developmental follow-up in order to thrive in school and grow up to be active contributors to our society.

With the proposed cuts to Medicaid and federal caps and lifetime limits on pre-existing conditions, we worry about the daily implications of these changes on families we see at Yale New Haven Hospital.

We watch as parents sit unfailingly at their children’s bedsides, and are saddened to think that these families may soon not only have to worry about whether the new chemotherapy regimen will be successful or if their child will come off of life support – but also about lifetime coverage and insurance caps for their medically complex children who would now be labeled as having a preexisting condition. This sentiment rings especially true for one of the authors of this piece.

For her, a high school cancer diagnosis would, under the American Health Care Act, mean being labelled as having a preexisting condition. This would make it potentially very difficult for her and millions of other survivors of serious childhood illnesses to receive the long-term follow up that is so necessary for them to continue to live their healthiest lives.

Additionally, by capping the total amount of federal funding that states could receive for Medicaid, states with limited programs and other risk factors would be unable to adapt to future changes.

We can imagine the impacts capping federal funding would have on Connecticut as it grapples with a rising opioid epidemic. Connecticut has surpassed the national rate for drug and opioid overdoses since 2013; this rise is also notable by the multiple neonatal abstinence syndrome babies that we have seen during our first year of pediatric residency training. Capping Medicaid funding would make it harder for states to respond adequately to unexpected events or health crises, including the rising opioid epidemic, leaving vulnerable patient populations at risk and with limited or no access to the care and resources they need.

The proposed caps are being touted as a way by which the government will save money on healthcare. However, these very caps threaten the child component of Medicaid – the Early and Periodic Screening, Diagnostic and Treatment benefit – one that ensures that millions of already high-risk children have access to full-spectrum preventive and necessary services at a relatively low cost-per-child.

For example, each Medicaid-eligible child costs Connecticut just $3,465 per year on average compared to the average cost-per-adult Medicaid enrollee of $6,075, demonstrating that the cost to provide meaningful health insurance for children is incredibly inexpensive, as children make up over half of all Medicaid recipients nationally but only account for 20 percent of the costs. Cutting the EPSDT means losing the peace of mind afforded by this benefit while gaining very little by way of monetary savings.

Any legislation that cuts or caps Medicaid or denies guaranteed coverage for those with preexisting conditions is deeply concerning. Everyone has a story to tell and it is time to keep sharing these stories and urging our lawmakers to listen. The legislation the Senate passes should prioritize the patients it is designed to serve - not the politics.