How about health care as a gift for kids — let's pass CHIP this season

How about health care as a gift for kids — let's pass CHIP this season
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Yes, it is a timely and uplifting effort to raise money for children for toys for the holidays. But what they need is health care.

Nearly three months after the lapse of federal funding for the Children’s Health Insurance Program (CHIP), Congress hurriedly voted to extend its funding and to avert government shutdown.

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As physicians, we cannot let this recent last minute bill reassure us. It is a temporary fix to a major crisis to a state and federally funded program for children whose families don’t qualify for Medicaid or private insurance.

 

Several states had already notified families that they may lose coverage. In a few weeks, these families will again face the uncertainty — an unnecessary and unfair financial burden of losing insurance for their sick children.

In the neonatology units, we provide care to up to 100 infants per day with life-threatening conditions who require intensive medical support as soon as they are born.

Working at a major referral center and source of specialized health care, we see firsthand the effects of the CHIP program expiration on families of sick children. The infants we care for in the hospital face many challenges, but fortunately, have excellent access to specialized pediatric care, and many are covered by CHIP.

In Illinois, where we practice, CHIP falls under the program Illinois All Kids and has enrollment of over 325,000 children. Without federal action, the funds for these children will run out. That number is equal to the populations of Tampa, Florida or Arlington, Texas.

One of those critically ill children we recently cared for in the neonatal intensive care unit. The infant had complex medical needs due to prematurity, gastrointestinal problems and congenital heart disease. This baby will have prolonged hospital stays including surgery and post-operative recovery. 

He will need equipment at discharge from the hospital, from feeding tubes to ventilators requiring around-the-clock home nursing. The family asked our team how can they ensure their baby receives the care he needs. The father works seasonally as a construction worker and while they can afford private insurance in the summer, they rely on CHIP to provide coverage in the winter when he is not insured.

The costs of his care without insurance could approach hundreds of thousands of dollars. Without this care, he will likely die.

As he grows, this child will also need early intervention services for physical and occupational therapy, as well as social work support, daily medications and multiple visits to the hospital during his childhood years. Without CHIP, we could not care for these patients using the most advanced technology available. 

Children do not account for the majority of health care costs in the United States. CHIP represents $16 billion of the total $553 billion of Medicaid spending, a mere 3 percent of the total expenditure.

A 2014 Kaiser Family Foundation study shows that this investment has led to meaningful gains in access to care and the quality of care for low-income children. It has provided a safety net for children in working families during economic downturns.

A National Bureau of Economic Research study in 2014 shows that expanding health care coverage through CHIP has had a spill-over effect including increasing rates of high school completion and college completion.

To be sure, everything that a society chooses to provide as a basic right or a safety net has a cost that must be met by generation of revenue. Some might argue that if children don’t qualify for CHIP, they can go on Medicaid. This is not true, as CHIP provides health care to children whose families do not qualify for Medicaid.

Institutions like St. Jude’s Children’s Research Hospital provide free care to 8,500 children a year, but this is a rarity in pediatrics and could not absorb all our patients.

We can debate whether health care is a fundamental right and therefore, should be guaranteed for all citizens of the United States. But certainly we can agree that we need to protect sick infants and children.

All aspects of children’s health are at stake when we talk about ending CHIP care. It will affect children with rare and complex diseases. Some children will receive insufficient care, or no care, and some will die.

We have simply postponed solving the problem to three months from now. But we have time to act.

It is important to organize and call local representatives, and encourage parents to continue to put pressure on legislators.

As pediatricians, it is critical to pursue this campaign. With a commitment to save the littlest, most ill and vulnerable children, legislators need to understand the critical nature of the work done on behalf of children.

In these unusual times, with the passage of a $1.5 trillion tax cut and the recent threat by Sen. Orrin HatchOrrin Grant HatchGOP opens door to holding Kavanaugh committee vote this week Press: Judge Kavanaugh must withdraw Hatch: Second Kavanaugh allegation is 'phony' MORE (R-Utah) to deny health insurance to those who “don’t lift a finger,” it’s time to remember the words of another President, Franklin Delano Roosevelt.

As FDR said in 1937, “The test of progress is not whether we add more to the abundance of those who have much, it is whether we provide enough for those who have too little.”

Nana Matoba, M.D., is an assistant professor of pediatrics in Northwestern University’s Feinberg School of Medicine, a neonatologist at Ann & Robert H. Lurie Children’s Hospital of Chicago, and a Public Voices Fellow through The OpEd Project.

Angira Patel, MD, MPH, is assistant professor of pediatrics and medical education and a member of the Center for Bioethics and Medical Humanities, both at Northwestern University Feinberg School of Medicine, a pediatric cardiologist at Ann & Robert H. Lurie Children’s Hospital of Chicago, and a Public Voice Fellow through The OpEd Project.