As the United States Senate prepares to vote on its health care reform bill, the Better Care Reconciliation Act, it’s important to keep in mind that more than 30 million children in America rely on the Medicaid program to stay healthy. The massive Medicaid cuts now included in the bill would seriously jeopardize access to quality health care for millions of children.
Medicaid is the federal-state program that covers children and families living in or near poverty, children with disabilities, children in foster care, and newborns in low-income families. It also pays for nearly half of all births in the U.S.
As neonatologists who care for babies born sick or prematurely, we know firsthand the vital importance of children having access to quality health care before and after they are born.
A provision of the health care reform legislation the House of Representatives passed in May would restructure Medicaid and dramatically reduce federal funding for the program. The Senate bill includes a similar provision. If legislation with these proposed changes to Medicaid passes Congress and is signed into law, states would be forced to pit children’s needs against those of other vulnerable groups, including individuals with disabilities and the elderly.
Federal matching funds to states currently expand or contract with the number of individuals enrolled or with changes in the cost of providing services. Proposals now under discussion would set limits on federal Medicaid funding and would shift responsibility to states to fill the gaps resulting from lost federal dollars. A change like that would put tremendous pressure on other funding needs — including support of our public schools, nutrition programs for women and children, and funding for child care — and could result in enrollment and benefit cuts for Medicaid recipients.
The positive impact of Medicaid on both individuals and communities is wide-ranging and profound. Children enrolled in Medicaid miss fewer school days due to illness, perform better in school, are more likely to graduate from high school and attend college, grow up to be healthier adults, earn higher wages, and yes, pay more in taxes.
Medicaid also provides access to health care services for young women, many of whom have chronic conditions that put them at greater risk for delivering high-risk newborns when they become pregnant. Medicaid provides these women access to care that helps identify high-risk conditions such as high blood pressure and diabetes that, if properly treated, can considerably reduce their chances of delivering a preterm baby or one who requires treatment in a neonatal intensive care unit.
For those babies who do require intensive care, the costs to their families can be catastrophic. Medicaid not only pays for those services but provides access to community-based primary care and hospital-based follow-up specialty care. Thanks to the Affordable Care Act, these children are no longer subject to preexisting condition restrictions or lifetime benefit limits.
Medicaid serves children in every demographic and every region. It is especially essential for economically disadvantaged children, particularly those in community-based medical and public health programs. Medicaid-insured children are disproportionately represented in most hospitals that care for sick children; 50 percent of inpatient pediatric hospital days are covered by Medicaid. Medicaid helps support the expert clinical staffing and the special equipment and supplies needed to care for sick children, whether in neonatal intensive care units or children’s hospitals. This means that children who face serious medical challenges like congenital abnormalities, cancer, and organ transplantation benefit from the Medicaid program even when their parents have employer-sponsored insurance.
In the United States, the infant mortality rate has declined by 76 percent in the half century since the creation of the Medicaid program. This is one of the most substantial reductions in mortality of an age group ever recorded and one of the most significant advances in public health in the history of our country. Medicaid has financed a major portion of the care required to achieve this remarkable result.
We are grateful for the efforts of federal, state, and local leaders who are fighting to protect this vital program. We urge senators to reject these cuts and eliminate the very real threat they pose to the health and well-being of our nation’s most vulnerable children.
DeWayne Pursley, M.D., is chief of neonatology at Beth Israel Deaconess Medical Center in Boston and president of the Massachusetts chapter of the American Academy of Pediatrics. John Zupancic, M.D., is associate chief of neonatology at Beth Israel Deaconess Medical Center and chair of the American Academy of Pediatrics section on neonatal-perinatal medicine.