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.
Alan L. Schwartz, M.D.,
Chairman, Department of Pediatrics
Peyton Manning Children’s Hospital at St. Vincent and
St. Vincent Women’s Hospital;