Healthcare reform - protecting our children

October 27, 2009

Child advocacy is a critical component of our mission at Children’s Memorial Hospital, and the current healthcare reform debate in Washington presents all of us an opportunity to speak out for children. We are paying close attention to the debate, and working with our advocacy partners, including the National Association of Children’s Hospitals and the Illinois Hospital Association, to try to shape the outcome so that it protects and enhances the health and well-being of children.

As we have these discussions, it is important for us to know what you think about this important and complicated issue. I would like to use this new communications tool to share what I know, invite you to contact your legislators and share your thoughts and ideas with me.

What is in these bills?

Both the U.S. House and Senate are drafting bills to expand healthcare coverage to more Americans. Those who are following the reform debate believe that final legislation will probably most closely resemble the package recently passed by the Senate Finance Committee. The major elements of this package include:

A goal is to make sure that 90% of United States citizens (an additional 30 million people) have health insurance.
A cost of about $830 billion that would be paid for through a combination of at least $400 billion in Medicare spending reductions and up to $500 billion in revenues from penalty fees on individuals who do not obtain coverage, taxes on health insurers offering expensive products, fees on pharmaceutical, biotech and device manufacturers, and other items.
A mandate that individuals obtain health insurance, with subsidies provided to those with incomes below 300% of the federal poverty level. Some small businesses would also receive subsidies for providing insurance.
Expansions in the Medicaid program to add all those with incomes below 133% of the federal poverty level to the program (about 14 million individuals).
The creation of insurance exchanges for other uninsured individuals to purchase health coverage from qualifying private insurers and non-profit cooperatives (but not a public plan).
A wide range of other reforms, such as linking provider payments to quality outcomes and strengthening the role of primary care providers.

What is NOT in these bills?

This debate presents a rare opportunity to ensure that healthcare works for our nation’s children. Children’s Memorial is one of the nation’s top children’s hospitals and the largest provider of pediatric Medicaid services in the State of Illinois. We want to improve upon the current system that offers tremendous benefits but also has many limitations. To accomplish this, a few critical components of the draft bills need to be revised:

Adequate reimbursement for pediatric specialists: In Illinois, pediatric specialists are reimbursed an average of 35 cents for every dollar it costs them to care for critically ill and injured children insured through the current Medicaid program. This is unsustainable, and causes lack of access to care, long wait times and over-usage of emergency rooms, which hurts children and drives up the cost of healthcare. At a minimum, pediatric specialists should be paid the same rates as adult specialists in the Medicare program.
Significant medical malpractice reforms: The Senate bill includes demonstration grants for medical malpractice reform. This is a good first step, but we need to go further to reduce the costs ($50-100 billion per year) of defensive medicine.
Protections for high-Medicaid hospitals: Because Medicaid reimbursement is inadequate, hospitals that have high Medicaid volumes receive special payments from the government called Disproportionate Share payments to provide some assistance in covering costs. These payments have been reduced in the proposed bills. If reimbursement rates are not increased and coverage targets are not met, we need to ensure that there is some protection for hospitals that serve high percentages of Medicaid patients and the uninsured.

What happens next?

Both the full House and Senate are expected to vote on bills within the next month or two. If both versions pass, a conference committee consisting of members from both chambers will get together to combine the bills into one for the President to sign. The goal is to enact final legislation by the end of the year.

What should we do?

It is urgent that we contact our Members of Congress to ensure that children’s voices are heard.

Also, I look forward to hearing from you about your thoughts on healthcare reform as this debate progresses. Please send me your comments using our secure, online comment form.