Threat to Medicaid Puts Children’s Health Care On the Line

Children’s Hospital CEO Perspective — Op-Ed by Christopher G. Dawes, President and Chief Executive Officer, Lucile Packard Children's Hospital Stanford and Stanford Medicine Children’s Health

An extended version of an article originally published on HuffPost April, 26, 2017

Children’s health and well-being are paramount to the success and stability of our state and nation’s future. However, often in health care policy discussions, the child population is overshadowed by the much larger expenditures generated by adult populations. As a children’s hospital and health system leader, I and my colleagues are committed to advancing policies on behalf of children’s health.

While the proposed American Health Care Act remains unresolved, our challenge for everyone, members of Congress and citizens alike, is to recognize the importance of Medicaid for children’s health. It directly impacts not only children on Medicaid but all children and the collective health system’s ability to deliver uncompromised quality and access to excellent care to all patients. 

In February of this year I joined other children’s hospital CEOs and health care leaders from California and throughout the country to discuss the importance of children’s health priorities with members of Congress in Washington, D.C. Our message to them was threefold:

1. Children are not small adults. They have different health care needs than adults.
2. Medicaid, the Children’s Health Insurance Program (CHIP) and the Children’s Hospital Graduate Medical Education (CHGME) program are the foundation of the entire child health care system. Cuts to these programs impact ALL children.
3. Collaboration with pediatric experts improves systems of care for all children, and investing in systems now reduces costs in the future.

U.S. Representative Jamie Herrera Beutler is one of those in Washington who champion children’s health, as she recently demonstrated in a call for an amendment to the AHCA to strengthen the Medicaid safety net for the children and adolescents who depend on it for their health care.  When the amendment was not adopted, Rep. Beutler expressed her resolve to ensure protection of vulnerable children in a press release on March 23.

I applaud Rep. Beutler’s commitment to prioritizing children’s health and her unabashed examination of the recently proposed health care act. As she stated in her press release, “Protecting vulnerable children is a core purpose of the Medicaid program and when the program fails to do so, it fails entirely. I will not vote to let those kids fall through the cracks.”

As we continue to review the proposals that will be introduced by members of Congress in the coming weeks, the lens children’s hospitals and advocates will be using is simple: does this protect children covered by Medicaid and by private insurance? Will it help them to be the healthiest they can be at a manageable cost?

Medicaid — the underpinning of the entire children’s health system

Medicaid, the joint federal and state program for people with limited income and resources, covers more than 30 million U.S. children, and another 6 million children are covered by the Children’s Health Insurance Program (CHIP). This accounts for nearly 40 percent of children in the United States and 54 percent of children in California. What is important to note is that the cost of care for children on Medicaid accounts for less than 20 percent of the Medicaid budget. Therefore, reductions to Medicaid disproportionately impact children.

At Lucile Packard Children’s Hospital Stanford, about 43 percent of our patient population is funded by Medi-Cal (California’s Medicaid program) or CHIP. Many of these families cannot afford employer-sponsored insurance or work in jobs where health benefits are not offered. Others have serious and chronic medical conditions that require ongoing treatment and therapy, much of which is not covered by private insurance.

Maintaining a robust Medicaid program is imperative. Otherwise the entire children’s health system suffers. If Medicaid funding is compromised, it not only affects that percentage of families who use it, but it destabilizes the entire system on two fronts: first, it reduces our ability to provide specialty programs for all chronically ill children, and second, it ignores the critical role of wellness care, early detection and preventative care for all kids.

Serious chronic illness in children is relatively rare. Thus, those cases must be concentrated in specialty care centers to ensure high-quality care. Research shows that when more patients are cared for by specialists, the quality of outcomes increases. The more times you perform a specific procedure, the more expertise you develop. Currently, there is a national shortage of pediatric specialists. When you consider the shortage of specialists combined with the fact that a relatively small population of children need specialized care, it becomes clear that the best health care system for children is a regionalized system that serves both Medicaid-funded and privately insured patients. These regional specialty care centers are essential, but even these centers face a shortage of pediatric specialists and subspecialists.  Historically, when Medicaid has been cut in California, the result has been a reduction or elimination of programs that provide specialty care services, which means all patients have less access to specialty care across the board, not just patients on Medicaid. 

Medicaid also provides vital access to the foundation of preventive primary care, including wellness care, immunizations, optometry and dental care. Primary care for the prevention of conditions like obesity and asthma, as well as for the detection of serious conditions, reduces medical costs down the road. From the pediatric hospital perspective, when children are unable to obtain wellness care, early detection and preventive care, treatable diagnoses can turn into terminal diagnoses. No family should ever have to face these circumstances because of their insurance status.

What children can’t afford to lose

Under the Affordable Care Act, children and their families have protections in place that sustain long-term care for chronic and serious conditions. A few of these are expressly important for the patient population of children’s hospitals like Packard Children’s, where we treat some of the most critically ill children in the country:

• Families can no longer be penalized or refused coverage for pre-existing conditions.
• Eliminating annual and lifetime caps on insurance coverage. Many of our high acuity patients would surpass annual caps in less than a year and lifetime caps in a couple of years. Removing this protection would put patient families at high risk for medical bankruptcy.
• Allowing children to remain on their parent’s insurance up to age 26.

The ability to remain on their parent’s insurance policy is important for adolescents and young adults.  Thanks to advances in science and medical treatments, including immunotherapy and stem cell transplant, we are caring for children affected by once-deadly diseases into adolescence and adulthood.  This evolution in care has created new needs for that population, including comprehensive, long-term medical coverage for conditions like cystic fibrosis, cancer and congenital heart disease.

In Northern California, Lucile Packard Children’s Hospital Stanford will continue to work with our local representatives and join the children’s hospitals in the state and the nation to remain vigorous advocates for children’s health coverage and access. I encourage the community to join us in this effort by connecting with your elected officials and voicing the need to maintain Medicaid, CHIP and CHGME funding to ensure all children have affordable access to quality health care.

About Christopher G. Dawes

Mr. Dawes joined Lucile Packard Children’s Hospital Stanford in 1991 and became its President and Chief Executive Officer in 1999. Mr. Dawes previously served as Chief Operating Officer of the hospital from 1995 to 1997. He served as a board member of the National Association of Children’s Hospitals and Related Institutions, now called the Children’s Hospital Association. He currently serves on the boards of the California Children’s Hospital Association, California Hospital Association and the Santa Clara Family Health Plan.