Six-year-old Jamela Anthony — wearing a black shirt proclaiming “I Kicked Cancer’s Butt” — ran through a hallway at Lurie Children’s Hospital toward a golden bell.
She rang it triumphantly, smiling before her mother scooped the tiny girl into a long, tight hug. Jamela rang it, a tradition at Lurie, to mark the end of chemotherapy more than a year after doctors found a type of rare, aggressive tumor on her spinal cord. She’s now in remission.
Jamela’s mother, Tangela Watson, is thankful for her daughter’s remission and that Medicaid, a state- and federally funded health insurance program, covered the costs of Jamela’s care.
“It helped out a lot,” said Watson, who lives on the city’s West Side. “That was one big thing I didn’t have to worry about.”
But Watson does worry about how the Medicaid program might change if the Senate’s Obamacare replacement bill becomes law.
Like Jamela, about 30 million children nationally and 1.5 million kids in Illinois — about half of all kids in the state — rely on the program.
Much of the debate over Obamacare’s future in recent months has focused on skyrocketing health insurance prices, consumer choice and whether able-bodied adults should have access to Medicaid. The effects of replacement bills on children, however, hasn’t received as much attention.
Proponents of the latest proposal, the Senate’s Better Care Reconciliation Act of 2017, say it will help rein in federal spending on Medicaid while still protecting the nation’s most medically needy children.
Opponents, however, fear the bill, which would reduce projected Medicaid spending by an estimated $772 billion between 2017 and 2026, would disproportionately hurt children because they make up such a large part of the Medicaid population. Kids sometimes qualify for Medicaid even when their parents don’t based on family income.
The bill, which the Senate may vote on in coming weeks, proposes, among other things, capping the amount of federal dollars states receive per person on Medicaid, starting in late 2019. Leaders of a number of Chicago-area children’s hospitals say the caps could lead states to cut payments to doctors, cover fewer services and make it more difficult for hospitals to provide pediatric care.
“It’s not good for kids,” said Mike Farrell, president of Advocate Children’s Hospital. “The bill, basically in our minds, is a bit of a step backward.”
About 56 percent of Advocate Children’s Hospital’s patients are on Medicaid — a statistic that’s not unusual for children’s hospitals. If the Senate bill were to pass, and the state were to cut Medicaid payments to providers, it’s possible the hospital might have to reconsider the proportion of Medicaid patients it’s contracted to treat or rework some of its programs, Farrell said.
The University of Chicago Medicine’s Comer Children’s hospital could face similarly tough decisions, said Dr. Daniel Johnson, vice chair for pediatric patient care services at Comer.
Lurie Children’s Hospital might have to delay or forgo investments if the Senate bill passes, said CEO Patrick Magoon.
Local children’s hospitals also worry that lower payments to doctors could mean fewer primary care pediatricians willing to treat children on Medicaid. Kids who aren’t getting regular primary pediatric care may wind up in hospital emergency rooms more often, they say.
“Our biggest concern has been for kids who don’t need to be in our hospitals, that need basic dental care, basic pediatric care,” said Mark Wietecha, CEO of the Children’s Hospital Association, which represents more than 200 children’s hospitals across the country “That’s where we’re going to have some real hell.”
Supporters of the bill, however, have praised its overall tightening of Medicaid spending.
Tom Price, Health and Human Services secretary, has heralded the bill as “much-needed relief from Obamacare” that will bring down the cost of coverage and expand choices.
Also, most of the projected $772 billion reduction in Medicaid spending would be because of changes to Medicaid for adults, said Avik Roy, who served as a health care adviser to former presidential candidate Mitt Romney and founded the Foundation for Research on Equal Opportunity. He also said the Senate bill would give states more flexibility to make Medicaid spending more efficient.
Robert Moffit, a senior fellow at the conservative Heritage Foundation, said limiting the amount of federal dollars states receive per person on Medicaid is an appropriate way to help control spending.
“One of the biggest problems we have in terms of the fundamental future of the United States is we have an entitlement problem,” Moffit said. “Entitlements are driving deficits and deficits are driving debt.”
Plus, the Senate bill would exempt disabled kids from the new proposed funding limits, allowing them to continue under the current funding formula, he said.
But the exemption wouldn’t necessarily apply to all kids with disabilities or major health care needs, said MaryBeth Musumeci, an associate director at the Henry J. Kaiser Family Foundation’s Program on Medicaid and the Uninsured.
The Children’s Hospital Association estimates the exemption would apply to about 1.5 million to 1.8 million kids across the country, out of the more than 30 million kids on Medicaid.
It’s not totally clear, for example, whether a child like Jamela would qualify for that exemption, which would allow the state to continue to receive matching dollars from the federal government for her care, or if her funding would be capped.
Jamela has been slowly recovering since she finished chemotherapy. She’s quick to smile and eager to get outside to play and climb, but her mother still is keeping a close eye on her, making sure she doesn’t overdo it or fall.
Lurie plans to fly Watson and Jamela to Washington, D.C., this week, so Watson can talk at an advocacy event about what Medicaid has done for her family.
“It’s very important that our voices be heard before they make these drastic decisions for our children,” Watson said. “At least they can hear us and see what we’re saying, so they can hear our kids’ stories.”