Dear Member of Congress:
 
On behalf of the 6,000 primary care pediatricians, pediatric medical subspecialists, and surgical specialists of the American Academy of Pediatrics in New York State and the 4.8 million children they care for, we want to express our gratitude for your ongoing efforts on health reform. Pediatricians are committed to the attainment of optimal physical, mental and social health and well-being for all infants, children, adolescents, and young adults, therefore, the Academy has actively supported the goals of national health care reform from the start of the process.
 
Both the Senate and House bills take significant steps toward achieving the Academy's highest priorities for health reform. These priorities include coverage for all children in the US, age-appropriate benefits in a medical home, and appropriate payment rates and workforce improvements to allow access to covered services. As you begin the legislative reconciliation process, we respectfully offer our highest-level requests for what will appear in a final health reform package. And we ask that you focus on the special needs of children, families and pediatricians in New York State.
 
Coverage for all children.  Of highest priority is that the number of children in New York and throughout the country covered by quality health insurance should increase as a result of health reform. No child should lose coverage or experience a reduction in coverage as a consequence of national health care reform. New York state provides CHIP coverage to children in families with incomes up to 400% of poverty.  We also cover our youngest children and pregnant women in our Medicaid program in some instances up to 300% of poverty.  Any reform must support the coverage we already have and help our state and others move toward affordable universal high quality health care for all children. If there are to be changes to the current CHIP program, then those changes must strengthen and enhance coverage for children not limit or reduce it in any way.  Because we know that coverage has an excellent correlation to improved health outcomes, we favor prioritizing high quality universal coverage for all children.
 
Age-appropriate benefits in a medical home.  Both bills provide age-appropriate benefits in the Exchanges, but the minimum benefit package for children is superior in the House bill due to its inclusion of hearing services. However, neither bill provides for the assurances required to provide the full services of enhanced primary care that the Academy's Bright Futures model offers to all children in a universal package. Beyond the Exchanges, however, the Senate bill would immediately provide all services included in the HRSA-approved consensus guidelines embodied in Bright Futures.  This provision may go farthest in bringing the appropriate preventive benefits to children in the US and across New York, as the vast majority of children are covered by private insurance. But it does not create a level playing field for all children. Regarding the medical home provisions (health home in the Senate), we believe that the House provisions are superior.  As you know, the medical home concept was developed by the Academy in conjunction with families of children with special health care needs.  The House provision (sec. 1722) is appropriately resourced, and the clarity of the community-based structure and primary care practice structure is superior in our judgment.

 

Appropriate payment rates to provide real access to care.  The lack of any attention to this glaring issue in the Senate bill could cause the Academy to withdraw support for health reform.  Medicaid payment rates nationally hover at around 72% of Medicare. Here in New York they are even lower. This has a real impact on current care under the Medicaid program because pediatricians must limit the number of children covered by Medicaid that they can afford to see and still maintain functional business models.  We find it very troubling that both bills would establish a system wherein children who are already covered are valued at less than new enrollees in Medicaid due to the much larger federal matching percentages that states will receive for new populations.  The structures in both bills create incentives for states to cut services to current enrollees in Medicaid, but at least the House bill recognizes that states often cut provider payments during inevitable economic downturns.  The Academy far prefers the House's attention to this incredibly important issue.  Please retain Sec. 1721 from the House bill in the Conference agreement.  The Academy also wishes to highlight the pediatric subspecialty workforce provisions from the Senate bill (Sec. 5203), which should be retained in any conference agreement.
 
The issues of fair payment and retention of all children in existing coverage are especially important here in New York.  New York has one of the lowest Medicaid payment rates in the country. And one of the lowest federal Medicaid matches.  As you may know, the state is currently working to enhance Medicaid payments to doctors who provide a medical home, and who are willing to meet national quality standards.  This effort has the goal to improve quality care and to encourage more providers to take Medicaid patients into their practices. And federal initiative must support this state effort, or as a result of federal action we may see thousands of children not only lose their coverage due to eligibility shrinkage, but also not be able access care because there are no providers available to provide health care services in some of our already underserved communities.
 
As a New York legislator, you owe your allegiance to the children and families in your District.  Please do not support any legislation that will reduce health care coverage for the children and families in New York.  We must preserve and strengthen our Child Health Plus and our Children's Medicaid programs, not reduce and weaken them, and try to call the cuts health care reform.
 
We look forward to working with you as the legislative process finalizes.  However, we cannot support a conference agreement that fails to provide appropriate financial and programmatic aid to New York to keep all of our children covered with affordable, high quality health care.  We cannot support a solution that creates more problems for families and children and more challenges to struggling pediatric practices by ignoring the glaring inequities of Medicaid payment. 
 
If you have any questions or need additional information about our position or about the needs of children and families in New York for real health care reform, please do not hesitate to contact me.
  
Henry Schaeffer, MD, FAAP
Chair
AAP, District II, NYS