Recently, while doing some errands, I heard a Christmas carol that asked a simple, yet profound question: "Do You Hear What I Hear?" The song was composed 50 years ago, when our country was facing a man-made emergency brought about by the ill-advised decisions of political leaders: the Cuban Missile Crisis. In October 1962, when Noel Regney and Gloria Shayne composed what has now become a Christmas classic, they were terrified by the looming threat of nuclear war, but found inspiration in the innocence of children. They wrote "Do You Hear What I Hear?" as a clarion call for peace on behalf of young people. Fifty years later, our country is watching the ticking clock of the "fiscal cliff," yet another man-made emergency brought about by the ill-advised decisions of political leaders. Though nuclear annihilation is not at stake, I am worried about children being caught in the crossfire as members of Congress take aim at Medicaid and other social programs in order to fix the deficit. As a pediatrician, with the well-being of children in mind, I ask Congress, "Do you hear what I hear?"
I hear and see my patients in southeast Washington, D.C., one of the poorest communities in America, getting health care and a lifeline through Medicaid. The patients I see are among over 30 million children across the country (that's over 1 in 3 children in America) getting health coverage through Medicaid and CHIP. Thanks to these programs, and the commonsense improvements made to them through the Children's Health Insurance Program Reauthorization Act of 2009 as well as the Affordable Care Act, the number of uninsured children in America decreased from 6.4 million in 2009 to 5.5 million in 2011. That is at an all time low. What makes this accomplishment even more remarkable is that it has occurred during tough economic times. Furthermore, children make up half of the people enrolled in Medicaid, but child health expenditures are only 20 percent of Medicaid spending. Between 2007 and 2010, Medicaid spending grew by only 2.5 percent per year per enrollee, which is significantly less than the growth of 5.5 percent per year that occurred per person enrolled in employer-sponsored insurance. Do you hear the bang for the buck?
It is also worth hearing how much parents appreciate Medicaid's role in their children's lives. In a 2011 survey, 66 percent of parents with children enrolled in Medicaid reported being very satisfied with their coverage (another 27 percent said they are somewhat satisfied), compared to only 48 percent of parents with children covered by employer-sponsored health insurance. Parents' appreciation for their children's Medicaid include their experiences with the actual health care: 93 percent of parents are very or somewhat satisfied with the quality of care their child receives; 89 percent of parents are pleased with how quickly they can get an appointment for their child to see a doctor. Again, these impressive grades in satisfaction have taken place during tough economic times, when state budgets have been forced to make drastic cuts to funding for their Medicaid programs.
Sadly, some members of Congress do not hear how Medicaid, despite its limited funding, is helping struggling families. Disastrous policies such as per capita spending caps and block grants are once again being considered as approaches to fixing the deficit. Currently, the federal government contributes at least 50 percent to each state's Medicaid program (the "match" rate varies state to state). Starting in 2014, if a state opts to expand its Medicaid program under the Affordable Care Act and cover more of its uninsured low-income citizens, then the federal government will pay 100 percent of the costs at first, and then gradually reduce its contributions to 90 percent. Under per capita spending caps and block grants, the federal government will leave the states hanging with significantly less support for their Medicaid programs, effectively worsening the budgetary challenges many states face now. States have already gone well beyond "trimming the fat" off their Medicaid programs: payments to providers and safety-net hospitals have been cut, and benefits have been reduced. Reduced federal funds through block grants of per capita spending caps will only put further strain on Medicaid, and undermine its vital role in the social safety net.
In the last verses of "Do You Hear What I Hear?" a shepherd boy says to a mighty king, living in his warm palace, "Do you know what I know? / A Child, a Child shivers in the cold." In response, the moved king tells his subjects, "Pray for peace, people everywhere!" These lyrics are as poignant now as they were in 1962, when the country was taken to the brink of nuclear war. Today, there are many children, disabled, and elderly who would be left in the cold if it weren't for Medicaid and the ongoing efforts of many to keep the program efficient and effective. Parents, pediatricians, and child advocates are asking Congress to hear what we hear, and to deliver the kind of peace once described by Martin Luther King, Jr. as "not merely the absence of tension; it is the presence of justice."
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