Category Archives: Advocacy!

Go ahead Congress, take your pick!

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 11M to their lucky kids, generates 20B dollars and will be rescinded (at least in the house version).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

 

“Congress, Do Your Job!”

 

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!]

Medicaid snapshot

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

The kids are not alright. Call your Senator.

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.

Medicaid image 3

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

My testimony to the Members of the House Education Committee re: HB 1004, expanding early preK

Chairman Behning, and Members of the House Education Committee,

My name is Dr. Tony GiaQuinta. I am a pediatrician for Hendricks Regional Hospital, and the vice-president of the Indiana Chapter of the American Academy of Pediatrics, representing over 800 Hoosier pediatricians. I am very proud of these credentials, but my favorite credential, by far, is father to two beautiful children, Margaret age two, and her four-year-old brother, Henry.

I am here today on behalf of Indiana’s pediatricians because we believe that success starts early, and therefore endorse an expansion of Indiana’s high-quality, pre-K commitment.

Our organization’s support is limited to funding pre-K. We are not here to either endorse, nor criticize, the school choice issue, which as been attached to this bill, as those are two separate issues. We would prefer pre-K be allowed to stand on its own sot that all sides can get behind this important movement.

You may be wondering why Indiana’s pediatricians would endorse an education bill.

Well, to begin, I’d like to share something neat my 4 year old did yesterday.

I was grocery shopping with my kids, and had somehow (some might say, miraculously), checked off everything on my wife Sarah’s grocery list. I had made it to the finish line, including the gauntlet of gum and candy at the register, when Henry asks the cashier for a sticker. She smiled, and gave Henry two. Well, Margaret saw that and just about flipped her lid. But then, something amazing happened: He put one sticker on his shirt, and took the other, and held it out to Margaret, to….share?

Wait. Is he sharing? Oh sweet Moses. This was it. Time slowed down as he held it out to her. A chorus of ‘alleluia’ started playing in my head. Never again would they fight, bicker, or taunt!

Well, it was a nice moment, but instead of handing it to her, he planted it square on her face. ‘A’ for effort… the execution needs some tinkering.  Thankfully, that was good enough for Margaret (and good enough for me, too) .

Why was this moment so significant, you might ask? Sure, as a dad, wanting your child to be a kind and sharing is something any parent strives for.

But as a pediatrician, I know that watching Henry offer that sticker for his sister, instead of himself, is a sign of a healthy brain developing and maturing.

The truth is, Indiana’s pediatricians know that house bill 1004 is so much more than an education bill. It is a bill that can protect and nurture Indiana’s most vulnerable brains.

You see, brain plasticity, or the ability of the brain to rewire itself in response to changes in the environment, declines with age. In fact, by age five, the vast majority of a child’s brain capacity is already developed. This creates a real, ‘make it or break’ timeframe when areas of the brain supporting memory and learning, can inextricably connect to the areas supporting social, emotional, and language development. If these connections are not formed by Kindergarten, they likely never will.

Conversely, when the environment fosters interactions that are sensitive and responsive to the child’s needs, neuronal connections are formed and reinforced that help the brain mature, and allow the child to succeed.  

Unfortunately, there is a large population of Hoosier children that are at grave risk of missing this important opportunity forever.  Specifically, this applies to 27,000 low-income four-year old Hoosier children that are at increased risk of suffering from toxic stress.  Toxic stress is the physiologic maladaptation of the brain and body to poverty and violence. Young brains exposed to toxic stress are unable to form the healthy connections between important brain structures. This disrupted brain architecture has significant adverse effects on physical and social emotional health across the lifespan.

High quality Pre K, however, rescues children from toxic stress by providing a secure, nurturing environment, strengthening healthy neural connections and setting a strong foundation for learning and adult success.

It is without surprise, therefore, that high quality preschool is associated with greater academic success, higher high school graduation rates, increased years of education completed, higher earnings, reduced juvenile crime, decreased adolescent pregnancy rates, decreased need for future special education services, and in sum a significant rate of return on investment.

Henry is lucky. He is in a high quality pre-K program, and the only stress he faces is getting his shoes on the right feet. Every day comes home from school with a full belly, and a brain further exposed to positive, stable, and nurturing influences that reinforce integral connections in his brain. He has every opportunity to succeed.

For 27,000 low-income four-year olds Hoosier Children, their toxic stresses and adverse experiences may see the window of their brain’s development, and window of opportunity for success, closed forever.  

Indiana’s pediatricians recognize that we are critical partners in this effort to keep children on the right track, and that partnership includes calling on our state leaders to recognize the importance of pre-K and sufficiently fund it to increase access. On behalf of Indiana’s pediatricians, we hope that HB 1006 is the feel good, everyone wins success story of this legislative session. By investing in high-quality pre-K and fulfilling a young child’s developmental needs, the long term benefits are realized not only by the child, but their children, their community, and our commonwealth.