GOP ObamaCare repeal bill puts kids in crossfire
© Greg Nash

As a nation, we are about to ignite a public health disaster — one that’s self-inflicted and entirely preventable. 

Imagine that an asteroid was projected to strike the United States, putting the health and well-being of millions of Americans at risk, including more than 30 million children, 40 percent of all kids in the U.S.
Would we want to evaluate the threat and develop solutions to avoid it primarily through a political lens, or as a way to reduce budget, or as an opportunity to cut taxes? Of course not. That would be missing the point that lives and perhaps the future of our nation is at stake, right?
Incredibly, that seems to be how Congress is proceeding as they seek to rewrite the nation’s healthcare law without House or Senate Committee hearings.
Over the past 50 years, remarkable progress has been made creating access to care for children living with congenital conditions, disabilities, catastrophic events, as well as mental and behavioral health challenges. The progress has been guided by a growing societal belief that we have a responsibility to provide all children with a chance to experience the best quality of life given individual circumstances. It has also made sound economic sense to take better care of children as they are the future of our nation. A key factor in our drive forward must be credited to the Medicaid program which covers nearly one half of all children in the country.
Make no mistake, what is being considered isn’t a “fix” — it’s a demolition and rejection of our commitment to children and their families.
As the president has noted, healthcare is complicated. That’s an understatement — access to health care is often a matter of life and death and lifelong well-being.
At Boston Children’s, we are part of the single largest primary care system of children throughout our state, caring for the most complex conditions and children from all backgrounds and unique needs. We know that a family may be happy one day, excited for the future, and the next, their lives are turned upside down and they are facing impossible decisions and often a new understanding of what their future will look like. These are families whose children require long hospital stays, highly specialized, coordinated care, and the most advanced technology imaginable. These are children who need us to do more, not less.
To avoid creating a system that does less for children we must have a full and public debate about what is a stake, who wins and who loses for each health reform proposal. Let’s evaluate critically whether or not children will be harmed by proposals to rewrite healthcare law—the following should serve as our minimum test of necessity:
1.       Overall Medicaid funding levels matter.  And within those overall funding levels we must ensure that adequate funding for children is preserved.  Currently, about 40 percent of all children in the U.S. rely on Medicaid. Cuts to this program would be disastrous for them and it appears there are very substantial cuts in both the House and Senate bill.
2.       Ensure children are provided medically necessary, timely, age-appropriate benefits. The House is undercutting this and it appears the Senate may similarly enable states to fundamentally restructure their Medicaid benefits by allowing states to opt out of Medicaid child health medical necessity standards under a block grant.  One of the challenges with the rushed process being used is that this important standard is open to interpretation in the Senate bill, with no opportunity to assure its continuation through the normal hearing, markup, and approval process. Both bills similarly enable states  to alter or eliminate requirements that commercial insurance plans cover essential health benefits.
3.       Protect children with pre-existing conditions, including protections against rate increases that push the cost of insurance beyond a family’s means.  Many families of teenagers have written me with deep concern about what happens when their children turn 18.  The House bill fell hardest on low income patients; the Senate bill will require extensive analysis to assess the extent and impact of apparent changes in the subsidy program.
4.       Healthcare providers like Boston Children’s should be challenged to play active roles, not just in improving patient care, but containing costs. We must continue to create payment and policy incentives to treat the whole child holistically, and continue to improve our capabilities to address social determinants of health in targeted, cost-effective ways.
These are not new issues, but they are absent from the current discussion. In the interest of families everywhere, we all need to stop cutting corners and focus on what really matters:
How will change impact children? These are the children who will one day lead our country, provide for national security, guide our universities and corporations, and teach the generation that will follow. The House of Representatives moved without transparent or thorough discussion of the issues. For the sake of more than 30 million children and their families—for the sake of our future— the Senate must do better.
Sandra L. Fenwick is President and CEO of Boston Children’s Hospital, ranked #1 children’s hospital by US News World Report.  

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