Children Are a Critical Piece of the Health Reform Puzzle

    Posted September 1st, 2009 by

    As a mom and a child health advocate, I am deeply concerned about our children who rely upon the Medicaid program and their ability to access specialty care. Medicaid is the largest insurer of children. One in four children in this country depends on Medicaid for health care coverage.

    Pediatric specialists serving Medicaid children are seeing more patients than ever before while their practices are operating under crushing financial pressure. In Illinois where I live, these physicians are paid by Medicaid approximately 35 cents for every dollar it costs to care for critically ill and injured children.

    I have had the honor and privilege of working at Children’s Memorial Hospital in Chicago for eleven years. Our hospital has spent decades attempting to correct the fragmented system of health care services and financing that exists for children. Daily we see the weaknesses of that system in the conditions of the patients we treat.

    Pediatric specialists who care for our most fragile children can no longer afford to continue participating in Medicaid, making health care less available to thousands of children in need of care.

    As Congress and the Obama administration work to reform our nation’s health-care system, the debate has centered on the escalating cost of health insurance to the consumer and coverage for the poor and unemployed. But health-care reform that does not also increase funding for specialty care for poor and uninsured children, or reform that cuts reimbursement to these critical caregivers, is not reform at all. Under Medicaid, Illinois pediatric specialists are reimbursed at rates approximately 50 percent lower than Medicare — the government-sponsored health-insurance program primarily covering seniors. This discrepancy in reimbursement is forcing pediatric specialists in Illinois to leave the Medicaid program rather than struggling to keep their practices afloat by getting paid a fraction of what it costs to care for seriously ill or injured children.

    In addition children are waiting six months or more to see the remaining participating specialists such as neurologists or endocrinologists are all too common. The shortage is forcing many children into the emergency room — a costly and inappropriate alternative. Unfortunately, Illinois is far from alone. The Medicaid program is failing children across the country.

    The current U.S. House bill begins to recognize the inequity of our Medicaid system by proposing to increase primary-care physician payments under Medicaid to 100 percent of Medicare by 2012. The bill, however, does not increase reimbursement for pediatric specialists and that is a shortcoming that must be addressed.

    It is imperative that we urge Congress to address inadequate Medicaid payments for pediatric specialists as part of health reform so that our nation’s children can access the essential medical care they deserve. Please join me in raising your voice today at www.SpeakNowforKids.org. The Speak Now for Kids campaign is non-partisan and is focused on making sure our elected officials remember children as they are reforming our health care system. Our children need you more than ever.

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    3 Comments

    September 3, 2009 at 11:17 am by Jennifer Christine

    Cordless Phones disagreement with chris based on the premise that the practice of our government system is flawed but not the principle, is actually supporting chris’ argument. No one disagrees with the principle that drives the current government health system, but it’s the way the government runs their programs that is causing the problems within our national healthcare system. So why is the practice of our government health system flawed? Because it is run by bureaucrats and lobbyists who are paying off politicians to get benefits and services covered for their consituents. Government wants to monopolize the market so that it can dictate to doctors and hospitals what they must do. We have enough experience with government monopolies to know that this is bad for America. Medicare is near bankrupt and running as a pay-as-you-go program with millions of baby boomers growing the programs costs and services. The President tells us that a government option would help keep the costs down for competitive commercial insurance options. But in the same breath, he says that he intends to carve out $500 billion in waste out of the Medicare program. WHAT? How can any government healthcare option be the benchmark of efficiency for other private healthplan options when the government’s own attempts to manage its Medicare program is fraught with so much overspending and waste?
    I want to see our healthcare system reform, but do not see any viable option that involves our clunky, partisan, souless, government.

    [Reply]

    September 3, 2009 at 5:24 am by Cordless Phones

    I disagree with previous comment.

    Just because a system is flawed in its practice it doesn’t mean it is flawed in its principle.

    The much rest of the world runs goverment healthcare systems which use less resources and bring a higher life expectancy in the US.

    If anything is ceratin the current private insurance system is broke.

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    September 2, 2009 at 3:23 pm by chris

    The two government healthcare programs, Medicaid and Medicare, are responsible for the physician shortages we see in healthcare. I too work in healthcare and am amazed at the march towards a government program as the solution to our healthcare problems. Medicaid and Medicare programs are underfunded, over-utilized and lack any form of utilization management. They are truly the most inefficient programs that balance their growing budgets by reducing the fees they pay hospitals and physicians. The result is that more and more physicians are opting out of the program, or choose to care for these members for free rather than deal with the government paperwork. Those who work in the healthsystem know this well.

    [Reply]

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