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Dr. Steve Allen

Dr. Steve Allen

Posted: March 29, 2010 09:26 AM

The Gap Between Expanding Access And Ensuring Care For Children

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As President Barack Obama signed the landmark health care overhaul into law this week, it seemed appropriate that the person standing closest to him was an 11 year old boy. When health care fails, children often pay the greatest price -- whether it is babies born prematurely to mothers who cannot afford prenatal care; or toddlers who lack necessary immunizations; or grade schoolers who suffer in silence with asthma; or adolescents struggling to manage diabetes or psychiatric disorders without a guiding medical hand. For all of them, this new law will make a difference.

But as the chief executive officer of a children's hospital accountable for the care of 280,000 children through Medicaid, I worry that adding 15 million Americans to the Medicaid rolls -- as this reform bill does -- will have the unintended consequence of decreasing access to care for all children. Across America today, parents already face two to three month waits for appointments with pediatric specialists. Simply covering more children -- without ensuring a ready supply of pediatricians -- will only expand wait times and undermine effective care.

Today, Medicaid provides comprehensive coverage to 57 million low-income Americans, almost half of whom are children, who would otherwise go without coverage. One of the reasons Congress chose to cover more uninsured families by expanding Medicaid is that it's cheaper than going through private insurance. That's because Medicaid typically reimburses doctors and hospitals below cost -- paying about 70 percent of what Medicare pays for most procedures. That is astonishingly low given that most members of Congress consider Medicare rates too low to provide seniors with adequate access.

In large part, Medicaid is a program that relies on the goodwill of pediatricians who love what they do and are willing to work for much less to serve children and their families. Unfortunately, Medicaid -- and the doctors who deliver it -- are beginning to buckle under the weight of impossible circumstances.

Pediatricians are caught between upward pressure on demand and downward pressure on cost. In states from California to Michigan to Georgia, doctors lose money with every Medicaid patient they see. As medical practice costs outpace reimbursements, an historic number of pediatricians are being forced to reduce the number of Medicaid patients they see -- or, in some cases, stop seeing them altogether.

As a result, many low-income families -- who are already hard-pressed to take time off from work and pay for transportation -- struggle to find a doctor. With 15 million additional Americans added to this already-desperate situation, we not only risk longer wait times; we risk making Medicaid a hollow promise: a safety net so shot through with holes that it provides little to no benefit to needy families.

The reform bill signed by the President begins to address this problem. Starting in 2013, the federal government will help states pay primary care doctors under Medicaid at the same rate as Medicare, which will provide welcome relief for many doctors. But a provision to equally reimburse pediatric specialists -- who account for a small but important percent of care under Medicaid, and often have months long waiting lists -- fell out of the bill during the last weekend of negotiations.

To improve the health care delivery system for children, Congress should find another vehicle to reimburse pediatric specialists at a rate that is at least comparable to Medicare. Otherwise, we run the real risk that the new health law will come in conflict with the law of supply and demand.

In addition, Congress should require that Medicaid increase payment to hospitals. Ohio children's hospitals alone lose more than $200 million each year in Medicaid reimbursements that fall far short of expenses.

Pediatric care should be recognized as an essential investment in our nation's health. Research shows that children with health problems like obesity, asthma, and diabetes go on to face a lifetime of chronic illness. At a time when chronic illness drives 80 percent of America's health care costs, ensuring full access to pediatric care is the best long-term strategy to bend the cost curve and build a sustainable health care system.