05/29/2010 05:12 am ET Updated May 25, 2011

All Eyes on California and Arizona as the Bellwether States Decide Future of Child Health Safety Net Programs

The passage into law of the Patient Protection and Affordability Act presents a historic moment in the health care narrative of our country. But health reform, and the promise it holds, comes at a time of budgetary crisis in our country, states are facing growing, long-term deficits and a lack of employment is impacting millions of families. Though the recently enacted health reform legislation provides federal support that protects the health care safety net programs administered by states, many provisions of the new law will not take effect until 2014 and beyond. And the stakes are highest for those with the most to lose: underserved children and families.

Certainly no one intends for those least able to bear a disproportionate burden during this recession, but many states will be forced to resort to Draconian cuts to remain solvent. This is already evident in states like California and Arizona where healthcare programs for poor kids and their parents have been slashed or eliminated. Unlike more resilient sectors of our society, the effect on children and families will be catastrophic.

Tens of millions of children across the United States are dependent on health care coverage provided through federal and state programs such as Medicaid and the Children's Health Insurance Program (CHIP) to get the services they need. The Obama administration recognizes the importance of children having access to health care. It has prioritized the needs of children, ensuring that adequate federal resources are allocated to states and that health reform legislation reinforces health security for children in the future. Federal government spending, however, is not constrained and can incur annual deficits. States enjoy no such leeway and they are legally bound to maintain budget balance. A report issued last month by the Center for Budget and Policy Priorities outlines the scope of what states are facing, citing the current recession as having caused "the steepest decline is state tax receipts on record". The buck truly stops in governor's mansions and state legislatures across the country. Ominously, the erosion of the child health safety net in states like California and Arizona are potentially just the beginning.

As a pediatrician, and co-founder of a national organization that brings health care to children in some of the nation's most medically underserved communities, I have witnessed the transformative impact of health access for children. Aside from the obvious health benefits, children with insurance and a regular source of medical care have are more likely to do well in terms of education and social development.

Children are the best investment we can make in the health care marketplace. Simply put, taxpayers, and future retirees should be re-assured by investing in children's health. We ensure a healthier, tax-paying citizenry for generations to come. Unfortunately, when the louder voices of special interests weigh in, children's interests are often marginalized.

As the battle for protecting the child health safety net moves to states, it would not be unfair to suggest that it's now the state governors' legacies that are on the line. Will each be remembered as a governor that cut or sustained critical health programs for vulnerable children when times got tough? All eyes will be on California and Arizona as their governor's actions will be pivotal, not only for the children of their states, but as a beacon for similar tough decisions regarding the health and well-being of children in states across the country.