The Children’s Health Insurance Program (CHIP) brought priorities to health insurance for children through federal reauthorization, and our Governor is likely to sign a bill in which funding for the Healthy Families program is restored. However, there remain millions of children living uninsured. Therefore, it is neccessary that the members of Congress and the President put their responsibility to finish the job of providing coverage for all our kids as first priority.
In negotiating the components of the final health reform package, members of Congress need to address the following principles:
1. Universal Children’s Coverage
Currently, six million children are eligible but not enrolled in public coverage programs nationally. Eliminating red tape and bureaucracy by simplifying the enrollment process is the most cost-effective, quickest, smartest and most cost-effective initial step toward ensuring that the lowest-income kids are insured. Any health care reform plan must leave parents a hassle-free way to secure coverage for their children through a “No Wrong Door” system that links them to any public program for which they qualify.
In addition, for children eligible for Medicaid or CHIP, lawmakers need to ensure that children will receive either comparable or better benefits, cost-sharing protections, and access to care under any new reform program. CHIP and Medicaid have cost-sharing protections, and Congress must ensure that children do not lose these under any new program.
2. Assure Children’s Access to Quality Health Care
Health reform must also address inadequate access to care by covered children. Although Medi-Cal covers 27% of California’s children, inadequate payments limit access to health care. Poor payment by California Children’s Services, which covers illnesses such as cancer and diabetes in children, has led to severe shortages of pediatric subspecialists in California. By federal law, Medi-Cal is required to provide access to health care equivalent to that of the general population; however, payment cuts are proposed without regard to the impact on patient access. The federal equal access law needs to be enforced.
Beyond reimbursement, successful models such as the medical home should be implemented. For example, North Carolina’s Medicaid program achieved savings of 0 million in 2006 alone by supporting medical homes that have supported physician-led improvements in care that reduce ER visits and hospitalizations.
3. Comprehensive Children’s Care
Real reform also means meeting the overall developmental needs of children, and providing access to comprehensive services, which not only includes primary and preventative medical care, but also oral and mental health. Congress established the Medicaid EPSDT program when the military rejected many young men from service because of preventable disabilities that were not identified and treated in childhood. Limits on health benefits are unacceptable for a country that wants its children to recognize their full potential.
4. Promote Wellness and Prevention
Our ultimate goal is to improve health itself. Thus, promoting wellness and prevention is essential to reform. Promoting wellness includes receiving a quality education, which is strongly linked with better health. Eating and physical activity habits formed during childhood may lead to obesity and related illnesses, estimated to cost California .7 billion a year in 2000. Access to quality food, parks, and physical education are essential to addressing this crisis. Clean air and water are also critical for the health of California. Children exposed to particulate pollution develop the lung disease emphysema at an earlier adult age. Let us also not forget that California’s investment in smoking cessation saved billion in personal health care costs.
All eyes are on Congress right now to enact the real health reforms that so many of California’s kids so desperately need. We cannot afford to let another generation suffer from our neglect. While we debate the role of government in health care, I hope we can all agree that children’s health is our top priority. Congress must get federal health care reform right this time because there are no second chances when it comes to childhood.
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