The fate of children’s healthcare is still in limbo
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One year ago, I embraced the decision to help lead Children’s Health Fund (CHF), an organization committed to providing comprehensive healthcare to the nation’s most medically underserved children. This is an exciting but staggering challenge because approximately 28 percent of children in the U.S. do not have full access to essential health services. That is a stunning call to action and is the driving force behind CHF’s strategic thinking and planning.  

There have been significant strides in the effort to provide health insurance coverage and access to care for children across the nation. Medicaid coverage was introduced and has expanded, same for the State Children’s Health Insurance Program (CHIP); those and the recent implementation of the Patient Protection and Affordable Care Act (ACA) mean more American children have insurance. But there are 20.3 million children younger than 18 who lack access to care that meets modern pediatric standards and expectations.

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The American Academy of Pediatrics guidelines call for core, minimum standards. These include annual well child visits for immunizations and preventive services, and management of any acute and/or chronic medical conditions. Children must also have access to mental health support, dental care and emergency services, including subspecialists.

Why does it matter? Failing to recognize and address barriers to health care threatens and undermines children’s wellbeing. It also directly affects a child’s ability to succeed academically and enter the workforce at their full potential. The stakes could not be higher.

Children’s Health Fund believes there are concrete strategies to ensure everyone has access to healthcare. Our research and three decades of practice identify financial and non-financial barriers that should immediately be addressed.

We must start by eliminating financial barriers to healthcare access. This can instantly be realized through reducing or eliminating copayments. The ACA should be amended to reflect that, and to reduce premiums, cost-sharing, and out of pocket payments for lower-income families. It should also increase subsidies and fix existing “glitches” that prevent families in need from gaining marketplace tax credits. The ACA and federal/state policies should also increase reimbursement rates for providers treating underserved communities.

Eliminating non-financial barriers to healthcare access starts with sending more health providers to poor communities. Policymakers must continue to create incentives to draw those experts to Health Professional Shortage Areas and retain those who are already there. This includes expanding the National Health Service Corps and equivalent state programs that reimburse/pay tuition or pay loans in return for service.

We also need to create more healthcare access points. This can easily be accomplished by increasing the number of Federally Qualified Health Centers and Rural Health Clinics, growing School-Based Health Services increasing the allowable reimbursement of telehealth for poor children and families and expanding utilization of mobile healthcare systems.

Children must be able to get to the doctor’s office, so transportation barriers should be removed. Targeted federal resources can help health clinics to augment public transit options and federal incentives can encourage states with low-income communities to improve coordination of federally subsidized transportation programs. Interventions to increase families’ access to cars and raising travel reimbursements can also be effective.

Finally, we must commit to eradicating health illiteracy. Simpler and more widely available materials that explain health plans can help parents ensure their children receive quality care. Healthcare professionals should be better sensitized to patients’ needs, there should be more staff dedicated to answering parents’ questions and additional programs to train parent mentors. There must also be a push to help parents with limited English proficiency and to increase clinics’ bilingual/multilingual capacity, including access to translation and interpreter services, especially in areas with large immigrant populations. Telehealth language services are useful in remote areas where on-site interpreters are not available.

There are at least 6 million more insured children now than in 1997, but there is work ahead. Key programs that helped to improve children’s healthcare like the CHIP and the ACA are not limitless. CHIP funding is set to expire in 2017, the ACA will doubtless be subject to revisions, the scope of which is impossible to determine.

Children’s Health Fund’s mission is to promote the extension and expansion of these initiatives as we move towards a truly universal health care system. It is critical we not forfeit gains made — we have come far; we owe it to our children to push through the last mile. 

Dennis Walto is executive director of Children's Health Fund, a US non-profit organization that provides healthcare to America's most vulnerable children. He has been at the front lines of poverty eradication and humanitarian relief in the United States and around the world for the past 25 years.   


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