Thank you Senator Charbonneau and members of the committee. My name is Dr. Tony GiaQuinta. I am a Fort Wayne Pediatrician, and the past-president of the Indiana Chapter of the American Academy of Pediatrics.

I am here today to testify in support of HB 1468, extra emphasis on the amendment that permits the Indiana Board of Pharmacy, in partnership with the Indiana State Medical Association, to develop a protocol to specify pharmacist training to enable self-administered birth control prescribed and dispensed at a pharmacy to individuals 18 and older.

Now, you may wonder why a pediatrician, charged with the health of Indiana’s children, rescheduled his clinic today to support a bill targeting women over 18.

In fact, I believe this amendment is above all, a bill that promotes the health and success of Hoosier children.

Here’s the gist: imagine if more pregnancies were planned and hoped for.

When I see a newborn in my clinic, I always share my excitement, proclaiming, “I’ve got big plans for this one!”

For many, a mother’s eyes will light up. I see her dwell in possibility: Thinking about how a one week old, will become a one year old, will become a high school graduate, will become a success… all in a blink of an eye. They are nervous, but they are ready. They’ve prepared for this. They finished their education, found some financial security, found a partner (if they choose), and decided to have a baby now that they are ready. This is what they’ve waited for.  

But for some moms, I feel their doubt.

Because they weren’t quite ready for this. They were in the middle of their education, (unplanned pregnancy is the #1 reason for mom’s not finishing college), or planning their career, or saving for a home. They were building for the success they dreamt of. For most, this includes dreams of having children. Just not yet. For 35,200 births each year, a mother’s dream is deferred.

Luckily, in my clinic, when I see doubt,  I wrap them in services, support, and reassurance. WE find them subsidized child care (9K per year), and endorse better paid parental leave and family friendly workplaces. The safety net, with an 800,000K per child price tag, has slowly expanded. And Thank goodness! Fortunately I can’t tell you how many of these mom’s, with time, encouragement, and social support, can focus on their child’s future. But there is a better, less expensive, more effective plan in front of us.

Let’s empower parents to have children when they are ready. HB 1468, by safely increasing access to contraception, would enable parents to plan for parenthood instead of drifting into it. The impact will mean decreasing the staggering high rate of unintended pregnancies, which equates to 55,000 pregnancies and 35,200 births each year in our state. Unintended pregnancies of course are linked to higher infant mortality, maternal mortality, as well as more abortions.  But when parents have planned for parenthood, Indiana wins. We win with healthier pregnancies, we win with a lower infant mortality, we win with healthier children, and a brighter future for Indiana.

As a pediatrician charged with our children’s health, screening and treating tobacco use is top priority in my office. You might not expect this from a pediatrician; however, I know that nearly 90 percent of smokers start using tobacco when they are kids. In addition, close to half of all kids are exposed to secondhand smoke, and more than 9,000 babies are born each year to Hoosier moms who smoke. Tobacco use, indeed, is a pediatric disease.

For decades, pediatricians like me have worked along-side families to curb tobacco use. But we need help, and our lawmakers have the prescription, right now, in this year’s legislative session.

Decades of evidence have shown us that significant cigarette tax increases are the most effective tool to keep kids from staring to smoke and to help adults quit.  The key word: significant. Passing small cigarette tax increases simply won’t fix what ails Hoosiers.  

Unfortunately, the Indiana House recently approved a 50-cent cigarette tax increase, which is unlikely to have a significant impact on smoking rates because tobacco companies will simply help consumers offset the increase with coupons, discounts and other price promotions.

 
Tobacco companies spend nearly $300 million per year in marketing in Indiana. About 80 percent of that budget is spent on price promotions – coupons, multi-pack discounts, and contractual arrangements with wholesalers and retailers that keep prices low for consumers.

 
The tobacco industry is shrewd. They use these discount strategies to target price-sensitive populations. And these strategies work. Research shows that tobacco cessation efforts are not substantially boosted after small tax increases and these price discounting tactics lead to young people progressing from experimentation to regular smoking.

 
It’s been fourteen years since Indiana last raised the cigarette tax – longer than most of my patients have been alive. As a pediatrician, I am doing my best to help kids remain tobacco free, but it is time for lawmakers to do their part. I am grateful lawmakers are considering a cigarette tax increase this year, but they should know 50-cents won’t do the trick. I join the 200 health and business groups who have called for a $2 cigarette tax increase. Our kids deserve it and the health of Hoosiers demands it.    

The Chicago Tribune (12/6/17) reports that Illinois has enough funding for its Children’s Health Insurance Program to last through September, according to the Illinois Department of Healthcare and Family Services = 250K children

The New Orleans Times-Picayune (12/6/17) reports Louisiana will exhaust funding for the state’s Children’s Health Insurance Program in mid-January if Congress does not renew federal funding. = 115K Children

The Tennessean (12/6/17) reports the “uncertain future of the Children’s Health Insurance Program, known as CHIP and called CoverKids in Tennessee, is worrying physicians and advocates as well as state officials who could be left to decide whether to use taxpayer money to continue the program if Congress fails to act. = 80K Children

The Dallas Morning News (12/6) reports Texas is considering “an accounting trick” to extend its Children’s Health Insurance Program “a few more weeks.” The Morning News says that “by not taking matching money from the federal government for kids who used to be enrolled in CHIP but are now covered by Medicaid, Texas can stretch the remaining federal funds.” State officials are exploring “contingency funding options.” The state requested an extra $90 million from the Centers for Medicare and Medicaid Services and expects an answer before Saturday

This is happening, and it doesn’t have to. So you know, the estate tax, applied to the monopoly guy/girl leaving behind > 11M to their lucky kids, generates 20B dollars and will be rescinded (at least in the house version). CHIP costs 15B, and insures 9 M kids (500K Hoosiers). For Orrin Hatch to declare “The reason CHIP’s having trouble is that we don’t have money anymore” is an insult to our decency as a society.

This is a non-partisan issue (77% of democrats and 63% of republicans support the program. I see these kids in my clinic EVERYDAY. They are good kids, that deserve the chance to succeed. Their success depends absolutely on being healthy. So I vaccinate them, screen them for developmental difficulties, check their hearing and vision, treat their illnesses, and get them into specialists when they need it. The Children’s Health Insurance Plan lets this happen.

Like early pre-K investments, an investment in children’s health pays off in many ways by not only by staving off potentially chronic illnesses down the road, but also enabling them to be productive members of our community.

It’s time to get our heads out of the sand, and realize that time is running out. Call your legislators and demand action.

-IndyPedsDoc

Rep Jim Banks Website

Senator Todd Young Website

Senator Joe Donnelly Website

A Call for Improving Our Healthcare System from the Peyton Manning Children’s Hospital at St. Vincent department Chairman, Dr. Alan Schwartz, MD FAAP

What is a politician?  At the most fundamental level, a politician is one who is engaged in government; usually an elected official.  A politician is someone, then, who studies and creates public policy for the betterment of society.  An honorable profession at its heart.  Where we often differ is in what society considers “betterment!”  I think we all can agree that those in government should, and for the most part do, care about the citizens they represent.  It is therefore puzzling that this pursuit of a healthcare policy for the betterment of the citizens of the United States has proven so contentious.

As a primary-care pediatrician in Indianapolis, I have the opportunity to provide health supervision to the most vulnerable yet most important citizens for the future of our community—our children.  As the chairman of the St. Vincent Hospital Department of Pediatrics, I am aware of the myriad and complex medical needs many of our children have and the barriers that exist to providing this care.  Now I am confident that our Representatives and Senators in Washington, D.C. did not set out to add to these barriers or to prevent our children from receiving the health supervision, preventative care, and medical treatments so important to their health, growth, and development, but, the political climate being what it is, that is exactly what will happen if the proposed policies of the House of Representative’s American Health Care Act (AHCA) or the Senate’s Better Care Reconciliation Act (BCRA) become law.

Under the current Affordable Care Act (ACA), those individuals with pre-existing medical conditions cannot be denied coverage nor can that coverage cost more.  Both the AHCA and the BCRA, while touting this same coverage, in reality allow for waivers for states which ultimately would lead to either increased patient costs for this coverage, or actual exclusion and elimination of coverage for some pre-existing conditions.  Why is this important?  Visit any major hospital Newborn Intensive Care Unit (NICU).  There you will find many “pre-existing conditions” ranging from congenital defects to pulmonary disease to extreme prematurity with resultant developmental and neurologic consequences.  Many of these medical conditions will be life-long and require ongoing evaluation and treatment.  How will these children become insured?  And at what cost, if coverage will even be available for them?  What about a child who develops asthma, cancer, or diabetes?  That is now a pre-existing condition when they become an adult.  [As an aside, I wonder how many pediatricians were consulted as the AHCA and BCRA were being developed!]

Did you know that children make up nearly 60% of Indiana’s Medicaid population?  Over 90% of eligible children are able to benefit from this Medicaid coverage. Were you aware that almost half of the pediatric patients treated at Peyton Manning Children’s Hospital at St. Vincent rely on Medicaid for their healthcare coverage?  Under the current ACA, thirty-one states (including Indiana) as well as the District of Columbia offer expanded Medicaid coverage.  In my pediatric practice, this allows hundreds of children to receive preventative healthcare, immunizations, and illness treatments; and allows tens of thousands of children to receive the specialized care that they need from the pediatric specialists in our state.  While advertising to the contrary, it turns out that both the AHCA and BCRA will ultimately reduce the effective funds available for our Medicaid recipients.  These proposed programs phase out federal funding for the Medicaid expansion thus leaving states to “pick up the tab” for this funding difference.  States’ budgets being what they are, it is unlikely that they will be able to do so.  This shortfall in funding can only lead to three outcomes: 1) Reducing the number of people who can receive Medicaid benefits; 2) Maintaining enrollment but reducing the amount of services available; or 3) Cutting payments to physicians, hospitals, and other care providers.  All of these options will lead to decreased care for the children of Indiana. [Lest anyone wonder how #3 inhibits care—Medicaid reimburses only a fraction of what Medicare might cover, and is often not even sufficient to cover costs.  Those of us who care for children on Medicaid do so because it is the right thing to do, however we cannot personally afford to subsidize the program!  If reimbursement is cut further, many physicians will have no choice but to leave the program, thus creating a gap in care for these children.]

Providing for the health of all of our citizens—children and adults—is not a Republican or Democratic issue.  It is a moral imperative that should reflect the values of our country.  There is no question that our current ACA has some shortcomings.  But recognize that much of the recent turmoil has been created by our current leadership disrupting the funding and structure of the ACA causing the very problems that they rail against!  The AHCA and the BCRA will not fix our system and in fact will only lead to more uninsured citizens and higher costs for those able to maintain healthcare coverage.  Let us work together to improve the ACA—give it a different acronym if that helps—but do not simply destroy it in the name of partisan politics.  

It is no coincidence that most major national physician associations, hospital executives, patient advocacy groups, and a large majority of American citizens oppose the AHCA and BCRA which were largely formulated without any consultation or input from those who know healthcare the best!  It is now time for all of us to let our elected officials know that we care about the health of our children, of our families, of our friends.  We will all be “patients” at some point—even those in Congress and in the White House!  We must, therefore, make sure that the healthcare system we implement strives for excellence in care for every American regardless of their economic status or existing health concerns. The health of American citizens should not be some prize won by the most “political points!”  The health of American citizens should not be sacrificed by short-sighted political promises made!  It is time for Congress to do their job and do what is right.  And with resolve but with respect, let us all encourage those who represent us to do just that.

Respectfully,

Alan L. Schwartz, M.D.,

Chairman, Department of Pediatrics

Peyton Manning Children’s Hospital at St. Vincent and

St. Vincent Women’s Hospital;

Primary-care Pediatrician

In the next two weeks, when you hear “funding cuts” or “caps” to Medicaid during any Senate discussion or debate (if there are any), you might be tempted to shrug your shoulders because either a) you don’t understand the implications, or b) it doesn’t affect you.

Please consider this: Medicaid, among other things, is insurance for children. A lot of children. 30 million children nationwide, of which 564,000 live in Indiana, making up 60% of Indiana’s Medicaid population. To be frank, Medicaid covers children who often need care the most. It is a lifeline for working families, and is relatively cheap, accounting for only 19% of Medicaid spending.

With Medicaid expansion, we are insuring children at historic highs well over 90%. Medicaid children receive all medically necessary care, including physician and hospital visits, well-child vistis and treatment, immunizations, dental, vision, and hearing services.

So why would anyone want to cut Medicaid? It is a political motive, not a public health strategy. Cutting Medicaid is the only way to fulfill a political narrative to financially reconcile the difficulties of promising ‘repeal and replace.’ Unfortunately, Medicaid enrollees don’t advocate for themselves. They are low-income and disabled children. This is stealing from the blind, and for a nation that so often espouses moral principles when advocating for legislative action, this should not happen.

Hoosiers have two senators. Call them! Be the squeaky wheel for children! Tell them when you hear “cuts to Medicaid” that you aren’t fooled. Tell them to protect children’s health care coverage and oppose any funding cuts or caps to Medicaid. These next two weeks may dramatically impact the lives of millions of children in this country. Time is limited. It’s go time.  

Senator Todd Young           DC: 202-224-5623      IN: 317-226-6700

Senator Joe Donnelly         DC: 202-224-4814       IN: 812-425-5813

Other Senator’s contacts found here: https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/Documents/Senator%20Contact%20List.pdf

IndyPedsDoc