What should we do about children’s health coverage?

Back in May, I was on a panel at the Pediatric Academic Societies to discuss health care reform, kids, and the future. After that panel, David Rubin wrote a post over at the Health Affairs blog summarizing his thoughts on what needed to be done.

Most of the people there were either pediatricians, or pediatric-focused, and, of course, we were all pulling our hair out at how little of the conversation nationally focuses on kids or families. So much of our discussion focuses on adults, and then when they’re done talking about them, they turn to the elderly. Medicaid and CHIP cover something like two in five children and Medicaid, even before the expansion, covered one-third of births, and those births produce kids. I’ve written before about how employer-sponsored coverage for kids has been eroding. I shouldn’t need to remind any readers of this blog that proposals for Medicaid in Republican bills come with severely decreased funding in the future.

David has some suggestions for focus:

CHIP reauthorization: While the AHCA works its way through Congress, some may not have noticed that CHIP funding expires this fall. Without re-appropriation, more than 8 million children may lose coverage immediately. States are already sounding alarms; they have been unable to project their CHIP budgets for next year. The immediacy of the CHIP re-appropriation debate in Congress offers a “NOW” opportunity to stake a new way forward and present pragmatic solutions to strengthen children’s insurance, embracing the realities that have reshaped the family insurance market.

Guarantee of essential health benefits: The most critical issue arising from any children’s insurance plan today, whether in the employer-sponsored or public insurance market, is the promise of a set of health standards to all children regardless of their insurance. The House-passed AHCA proposes removing the requirement of federally guaranteed essential health benefits from all plans. Should this become law, states will have the choice of whether or not to provide these benefits. So, one solution for protecting children is to require these states to provide families access to a CHIP plan that meets a comprehensive and standard set of federally legislated and guaranteed essential benefits, such as vision, developmental, and behavioral health screenings.

Private market reforms: Beyond essential benefits, it may be time to address the affordability and quality of dependent coverage on the employer-sponsored and exchange markets. We may need stronger caps on deductibles as a proportion of income, and limits to exorbitant cost-sharing for child dependents. Furthermore, prohibitions of narrow networks—or the increase of cost-sharing for enrollees who seek out-of-network services—in the pediatric market would go a long way to ensuring that families have critical access to pediatric subspecialty care should their children develop cancer, diabetes, or other debilitating illnesses. While narrow networks may work in the adult health care arena, they are not nimble for families whose children have special health care needs and require specialists based solely in children’s hospital networks that may be tiered out in such plans. All told, the private market is not working for families, and if Congress wishes to halt the migration of families onto public insurance, they may need to hold employers and commercial insurers responsible for their own contributions to crowding families out of that market.

Go read the whole thing. And remember it when people say that no one has any plans.


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