By Dr. Shetal Shah
The coronavirus pandemic has focused the nation’s attention on health care. Ironic that as the federal government allows patients’ access to their doctors during this public health crisis, it is simultaneously working behind the scenes to deprive care to low-income children.
While the need of health insurance coverage for children has never been more obvious, the federal government has been curtailing coverage for large numbers of children.
The Centers for Medicare and Medicaid Services recently pledged to support conversion of Medicaid insurance to a fixed block grant in willing states. This would fundamentally alter Medicaid and has disastrous implications for children. The measure will force more children away from primary care, increase preventable hospitalizations and make families over-reliant on the expensive emergency room.
Medicaid is the nation’s single largest insurer of children, nationally providing coverage to some 40 million kids. Children constitute 50% of all Medicaid recipients but use only 20% of costs, making them health care’s greatest bargain.
For kids, Medicaid coverage is associated with increased school attendance and higher grades. As adults, children covered by Medicaid are more likely to graduate college, earn more and be hospitalized less than uninsured children. Yet children are disproportionately targeted in Medicaid cost reductions.
Current proposals invite states to receive a set amount of money to fund their entire state Medicaid program. Since Medicaid already pays physicians and hospitals about 70% of private insurance (and less than Medicare’s adult rates), pediatricians can only afford to see a fixed number of Medicaid patients. These low-income children are formerly premature babies with lung disease, infants in foster care or children with chronic illnesses like diabetes.
One of my patients was born weighing less than 1 1/2 pounds and endured four surgeries within the first three months of life. If states convert to a capped payment system, I worry about where he will go when offices can’t see him. Multiple studies show when Medicaid payments are reduced, access to care for medically vulnerable children becomes limited. When Medicaid payments were increased slightly, more than 75% of pediatricians increased the number of high-risk, socially vulnerable children seen in their practices.
Coincidentally, Medicaid was tailor made to account for unexpected changes in the health care environment like pandemics, where costs of medical care increase dramatically. When pandemics occur, states and the federal government share the increase in costs. The goal is to incentivize states to spend prudently when it’s needed.
CMS has also proposed regulations about a provision called the Medicaid Fiscal Accountability Regulation. This measure gave states fiscal leeway so they could ensure Medicaid-enrolled children could see a local doctor. In high cost areas like New York, states were able to modify payments to account for our high cost of living. But new technical changes to the rule will limit states’ ability to make these adjustments. The result is fewer children will have a community pediatrician who knows them, their disease and their family.
Providing Medicaid for children without the financial supports that allow the system to operate is buying a car but refusing to pay for gas. My patients deserve better than health care proposals that sell them short.
Shetal Shah, M.D., is president of New York Chapter 2 of the American Academy of Pediatrics.