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Republican health reform proposals are disastrous for children’s health

I am a pediatrician. In that role, I take care of many children with special health needs. That means that they have a chronic disease, a health problem that won’t go away. They live with a disease every day of their lives. Overall in the United States, there are about 15 million children with special health needs. (https://mchb.hrsa.gov/chusa14/population-characteristics/children-special-health-care-needs.html ) That is nearly 20 percent of all children.

 

The percentages are similar in Kansas. There are 100,000 kids in Kansas today who have asthma, or autism, or cystic fibrosis, or lupus, or sickle cell disease, or diabetes, or juvenile arthritis, or ADHD or another chronic condition for which they take daily medication and need special health care services. These are the most vulnerable citizens in our state.

Luckily, there are programs to help them and their families afford the care they need. The most important of such programs is Medicaid. Medicaid is a state-federal collaboration. The states decide whether to participate and, if so, how much money to allocate from the state budget. The federal government then matches the state contribution using a complex formula that gives states more or less, depending on the level of poverty in the state. It is the primary source of funding for health care children of low-income parents, for long-term care for poor elderly people and for adults with significant disabilities. 

In 2016, there were 425,564 Kansans enrolled in Medicaid. Overall expenditures on the program were $3.4 billion, or about $8,000 per enrollee. Most of the money goes to seniors. Children make up nearly 80 percent of the beneficiaries, but they account for only 22 percent of the spending. (http://www.kslegresearch.org/KLRD-web/Publications/HealthCare/MedicaidPrimer_01-17.pdf)

For children with special health needs, Medicaid is essential. These kids require extra parental care. It is tough for parents to hold jobs. Even so, two-thirds of kids on Medicaid live in a family in which at least one parent works full time. (https://www.aap.org/en-us/Documents/federaladvocacy_medicaidfactsheet_kansas.pdf)  

These families cannot do this alone. With a little help, they do great. The kids are really tough. Their parents are heroes. Their brothers and sisters pitch in. The families are an inspiration to me and to all my colleagues in child health.   

Cutting the budget for Medicaid would be devastation for these kids, their families and children’s hospitals. Hospitals would be in trouble because about 60 percent of payments to children’s hospitals in the U.S. come from Medicaid. Cutting Medicaid would decimate our system of child health care and the families who depend upon it. 

Given all this, the two versions of Republican Health Reform, the American Health Care Act and the one making its way through the Senate, are like laser-guided missiles aimed at our children and children’s hospitals. The Congressional Budget Office estimates in Kansas alone, the bill would lead to 128,000 people being kicked off the Medicaid rolls. (For Missouri, it would be 500,000.) And these people couldn’t afford private insurance. Another 53,000 people in Kansas would be unable to afford insurance on the individual market. (For Missouri, that number is 148,000.) That is a lot of kids and families who would be abandoned. https://www.americanprogress.org/issues/healthcare/news/2017/05/25/433017/cbo-derived-coverage-losses-state-congressional-district/

Of note, there is bipartisan support for Medicaid. And bipartisan support is pretty rare these days. Many Republican governors think is essential to provide care for children, the disabled and the poor elderly in their states. The group of Republican supporters includes John Kasich of Ohio, Rick Snyder of Michigan, Chris Christie in New Jersey and Brian Sandoval in Nevada. Even President Trump called the ACHA “mean.”  

Who benefits from the bill? There are two primary beneficiaries. Families with incomes of $200,000 will get a tax break of about $5,000. Families making over $1 million will pay $51,400 less in taxes.

So, essentially, this is a bill that robs from the poor to pay the rich. It will make life harder for families taking care of children with special health needs. It will decimate children’s hospitals and small rural hospitals throughout Kansas. It will increase the number of medical bankruptcies. 

Clearly, Obamacare has problems. Clearly there are areas where it can be made more efficient and more equitable. Bipartisan efforts by moderates like Sen. Susan Collins of Maine point the way. But the two Republican bills that we’ve seen so far will take a bad situation and make it far worse for most Kansans. And most Americans. 

John D. Lantos, M.D., is a member of Congregation Beth Torah.