This op-ed from a current Congresswoman Diana DeGette (D-CO) makes the case that by using CHIP and Medicaid as a solid foundation, we can and should move forward on broader health reform. However, we know that even with the CHIP reauthorization advocates and policymakers can’t stop working to make children and kids coverage a priority. Rep. DeGette gives strong arguments why even as health reform moves along, we shouldn’t lose sight of the kids.
The Hill (DC) (Op-Ed) - Seize opportunity to meet Obama’s commitment to insure all children - By Rep. Diana DeGette (D-Colo.) – 4.23.09
DeGette is vice chairwoman of the House Energy and Commerce Committee.
The political and public will to reform our broken healthcare system present a unique opportunity for America’s children. We cannot simply rest on our accomplishment of reauthorizing the Children’s Health Insurance Program (CHIP) — we must build upon it. As Congress works with President Obama to reform healthcare, we must carefully examine children’s health policy and seize the opportunity to guarantee that age and developmentally appropriate health benefits are provided for every child in the United States. With the combination of private insurance, Medicaid and CHIP as a solid foundation, the goal of health reform should be to harmonize eligibility and enrollment rules and to provide children comprehensive and continuous coverage.
No population in our country, other than those over age 65 who are covered by Medicare, is as close to universal coverage as children 18 and under. If all children eligible for Medicaid and CHIP actually enrolled in those programs, the number of uninsured children would drop by approximately 70 percent. This is staggering. In fact, we could be halfway toward that 70 percent reduction in uninsured children if states voluntarily take advantage of the enrollment incentives provided for under CHIP. Yet even then millions of children will remain uninsured.
Comprehensive and continuous health coverage for all children should be one of the major objectives of health reform, whether through a mandate for coverage, automatic enrollment at birth with parental choice of coverage, default coverage to fill in if breaks in coverage occur, or a combination of these mechanisms. Ensuring that Medicaid and CHIP can work together with other sources of coverage — for example, through premium assistance or, in Medicaid’s case, as a secondary payer — can increase the stability of coverage for children and their families. However, Medicaid’s unique role in paying for services not traditionally covered by private insurance must be preserved.
In order to achieve seamless coverage, we need to eliminate pre-existing condition exclusions and waiting periods, and simplify the enrollment process. Unlike Medicare, enrollment in Medicaid and CHIP isn’t easy or automatic, and it isn’t the same for all eligible children. Making matters worse, states often build barriers to enrollment in the face of challenging economic conditions. Changes in family income, employment or employer-sponsored coverage, or moving to a new job or state, can all create significant breaks in coverage and the same delays in care as having no coverage at all. We can smooth the course for parents and children by addressing these issues and the many other complications that prevent our current public programs from reaching everyone who is eligible.
Children are not just small adults. Benefits for children in these programs should reflect their unique health and developmental needs with an emphasis on prevention and wellness. More and more young children are diagnosed with chronic diseases such as Type 2 diabetes, and many chronic conditions in adulthood have their foundations in childhood. Renewing an emphasis on primary care and a medical home, coupled with a child-oriented benefits package and/or medical necessity standard, will go a long way toward preventing chronic disease and improving health outcomes. Providing suitable healthcare for children, including preventive care, dental care and care coordination for children with chronic illnesses, can make a difference for a lifetime.
Children’s healthcare generally costs less than half that of adults. Most children are healthy and only require routine immunizations, basic primary and preventive care and treatment for acute illness or injury. We should encourage utilization of such care by eliminating barriers to access, such as co-payments and deductibles for preventive services. We also should recognize the importance of investing in such simple, basic care. For example, think about the case of Deamonte Driver, who died of complications arising from an abscessed tooth — access to appropriate dental benefits could have actually made the difference between life and death.
Both Medicaid and CHIP have been major successes in covering children, including children with special health care needs. Addressing key issues relating to enrollment, coverage gaps, access to care (particularly with Medicaid’s often low payments) and system reform will lead to better care for children and lower costs in the long run and in the delivery of children’s healthcare.
Health reform could potentially offer big gains or losses for children’s coverage. While the expansion of the children’s health program was an exciting win for President Obama and Congress, much more can be accomplished for children as we move forward with health reform. Keeping the status quo and failing to build upon the gains we have already made would be a loss itself. Children will need a special focus during the healthcare debate, and it is up to us to make sure that health reform will also work for them.