Christopher Dawes

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	The recent defeat of the Health Care Freedom Act in the U.S. Senate was a positive step in the fight to protect children’s healthcare. I’m grateful to the health care advocates who gave children a voice and fought to protect the quality care that they deserve. But, discussions surrounding the future of our nation’s health care policy are not yet over, and we must remain diligent in working with lawmakers in a bipartisan way to keep kids and their families covered.

	Continuing to protect Medicaid is as important as ever as we face the next pivotal healthcare decision: the reauthorization of the Children’s Health Insurance Program (CHIP). CHIP is a long-standing bipartisan-supported program that provides low-cost health coverage for 6 million children across the country, specifically for families whose incomes are too high to qualify for Medicaid, but who cannot afford private insurance. Its authorization expires at the end of September, and with that date quickly approaching, some lawmakers are considering a CHIP reauthorization bill as a potential vehicle for broader healthcare policy changes-including elements of repeal and replace and with that, a possible reduction to Medicaid.  

	Children’s health and well-being are paramount to the success and stability of both our state and our nation’s future. However, as often is the case in general healthcare policy discussions, the needs and concerns of the child population are overshadowed by the much larger expenditures generated by adult populations. Healthcare policy and legislative measures directly impact the collective system’s ability to deliver uncompromised quality and access to excellent care to all patients.

	There are four things that health executives, private insurers and the general population of the United States should know about how a failure to reauthorize CHIP, or cuts to Medicaid, would affect children’s health.

CHIP and Medicaid are the foundation for accessing pediatric specialty care. 

All children who require specialty care (even patients who are privately insured) rely on federally-funded coverage like Medicaid. Serious chronic illness in children is relatively rare-meaning those cases must be concentrated in specialty centers to ensure high-quality care. Research shows that when more patients are cared for by specialists, the quality of the outcomes improve. When you consider the shortage of pediatric specialists combined with the fact that a relatively small population of children need specialized care, it becomes clear that the best healthcare system for children is a regionalized system that serves both CHIP and Medicaid-funded and privately insured patients. All children benefit from the ability of children's hospitals to recruit pediatric specialists and to have the volume necessary to develop expertise. Historically, when initiatives such as Medicaid have been cut, as in the case of California, the result has been a reduction or elimination of programs that provide specialty care services, which means all patients have less access to specialty care across the board, not just patients receiving federally funded coverage.

Cuts to healthcare funding would impact all children. 

Many families covered by CHIP and Medicaid cannot afford employer-sponsored insurance or work in jobs where health benefits are not offered. Others have children with serious and chronic medical conditions that require ongoing treatment and therapy, much of which are not covered by private insurance. If healthcare funding is compromised, it not only affects the percentage of families who rely on it for coverage, but it destabilizes the entire children’s healthcare system on two fronts: first, it reduces our ability to provide specialty programs for all chronically ill children; and second, it ignores the critical role of wellness care, early detection and preventative care for all kids. Under the Affordable Care Act, all children and their families have protections in place that sustain long-term care for chronic and serious conditions. At Lucile Packard Children’s Hospital Stanford, the elimination of annual and lifetime caps on insurance coverage is expressly important for our patient population. We treat some of the most critically ill children in the country, and many of our high acuity patients would surpass annual caps in less than a year and lifetime caps in a couple of years. Removing this protection would put patient families at high risk for medical bankruptcy.

 Children have unique healthcare needs and thus healthcare coverage for children must be considered differently than it is for adults. Children require extra time, monitoring, specialized medications and specially trained health care providers. The epidemiology of child illness is the opposite of adults in that overall, children are well, and only a rare subset has serious chronic illness. Further, many chronic illnesses begin in childhood and can impact a child’s life course. Providing the proper care for children early on can have a significant impact on their health status in the future. Ultimately, the investments made in children’s health care now will pay themselves forward in many ways through the prevention of disease and promotion of overall health.

CHIP and Medicaid are lifelines for preventive primary care.

 Federal funded programs like CHIP and Medicaid provide vital access to the foundation of preventive primary care. Primary care can be the key to prevention of conditions like obesity and asthma, as well as detection of serious illnesses, which can help reduce medical costs down the road. CHIP safeguards access to care for low-income children by providing coverage for wellness visits, dental and vision care, immunizations, prescriptions and emergency services. Medicaid allows for EPSDT (Early Periodic Screening and Diagnostic Testing), which similarly ensures children receive necessary care they need to maintain healthy growth and development to avoid the health and financial costs of long-term disability. Currently, federal statutes and regulations state that children under age 21 years who are enrolled in Medicaid are entitled to EPSDT benefits and states must cover a broad array of preventive and treatment services. From the pediatric hospital perspective, when children are unable to obtain early detection and preventive care, treatable diagnoses can turn into terminal diagnoses. No family should ever have to face these circumstances because of their insurance status.

	I echo the recent statements made by the 

-we are grateful to lawmakers who voted to protect children, but the work is not over. As legislative discussions begin regarding the reauthorization of CHIP, it is imperative to keep in mind how proposed cuts could be detrimental to the health and future of our nation’s children. We must stand together to remain vigorous advocates for health coverage and access for our most vulnerable patients, including children.


	Christopher Dawes, is CEO and president of 

Stanford Children’s Health and Lucile Packard Children’s Hospital Stanford.

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