Surgery News - September 2007 - (Page 5) SEPTEMBER 2007 • SURGERY NEWS THE THE E SCHIP Funding Deadline Imminent BY JANE ANDERSON 20/20 / 0/20 V SION O SIO SION IO Else vier Global Medical Ne ws s lawmakers get back to work this month, the State Children’s Health Insurance Program is certain to be high on their agenda. The House and Senate each passed a version of SCHIP reauthorization before the August recess and are slated to work out differences in conference before the program expires on Sept. 30. However, an administrative change issued mid-August by the Centers for Medicare and Medicaid Services scaled back states’ ability to modify the program and may have the effect of dropping children from its roles. About 4 million children are eligible for Medicaid or SCHIP; some 6 million received benefits in 2006. An estimated 9 million children lack health insurance. Advocates of SCHIP, enacted 10 years ago, say it helps children who might go without care otherwise while opponents argue that expanding it would give backers of a single-payer health insurance system a foot in the door. Polls have shown wide public support for SCHIP expansion. And surgeons seem to want to see SCHIP not only reauthorized but also offered to more uninsured children. “It’s been an enormously popular program, particularly with those who deal with care of children—pediatricians and pediatric surgeons,” said Dr. LaMar McGinnis, a surgeon in Atlanta who is a fellow of the American College of Surgeons and vice-chair of the ACS Health Policy Steering Committee. “I personally, as a pediatric surgeon, think it’s a great program,” added Dr. Kurt Newman, executive director of the Joseph E. Robert Jr. Center for Surgical Care at Children’s National Medical Center in Washington, and an ACS fellow. The House on Aug. 1 approved by a vote of 225-204 a sweeping expansion of SCHIP, financed with a 45-cent-per-pack increase in the tobacco tax and with cuts in subsidies to private Medicare-managed care plans. The legislation would provide $50 billion to expand the program over the next 5 years and would add another 4 million children to SCHIP rolls. It also would prevent the cuts in Medicare physician payments that are slated to take effect Jan. 1. The Senate voted 68-31 on Aug. 2 to add $35 billion in funding, which would allow the addition of 3 million lower-income children to SCHIP rolls. The Senate version of the legislation also includes a hefty tobacco tax increase. But in an Aug. 17 letter from Dennis G. Smith, CMS Director for Medicaid and State Operations, states were told that if they were raising eligibility for children whose family incomes were equal to or above 250% of the federal poverty level, they would have to meet stringent new requirements. Many states have had such procedures in place, but CMS is now requiring that children be uninsured for at least 1 year before receiving SCHIP benefits. States also will have to prove that they’ve enrolled at least 95% of children who are below 200% of the federal poverty level, and document that the number of low-income children who are eligible for and covered by private insurance has not dropped by more than 2% in the past 5 years. The 18 states that have already increased their eligibility to 250% or more will have to comply with the new requirements within a year or lose some of their federal matching funds. CMS said the requirements should not harm children who currently receive benefits, but just how many children might be dropped is unclear. President Bush supports adding just $5 billion to SCHIP over the next 5 years and has vowed to veto any legislation that expands the program further. The Bush administration argues that expanding SCHIP would undercut private insurance by leading parents who otherwise could afford coverage to abandon it in favor of the public program. But Dr. Newman said it’s not reasonable to expect the parents of many uninsured children to purchase private health insurance—they cannot afford it. “Health care is expensive. Why put the children who are vulnerable at risk? This has provided a huge boost to families who otherwise couldn’t afford care,” he said. ■ Alicia Ault, associate editor for practice trends, contributed to this article. DATA WATCH Percentage of Uninsured Children Living in Poor Families 36.2%-48.0% 48.1%-55.0% 55.1%-62.0% 62.1%-69.0% 69.1%-73.9% Note: Based on children aged 0-18 years who are living in families below 200% of the federal poverty level. Source: 2003-2005 data, Robert Wood Johnson Foundation ELSEVIER GLOBAL MEDICAL NEWS C O M M E N T A R Y: WE MUST STAND TOGETHER TO SUPPORT CHILDREN resistance to the State Children’s Health Insurance Program (SCHIP) at best persistent greed, and at worst outright, downs of a SCHIP legislative effort that, unjust prejudice. A case in point: the on the surface, looks partisan, parochial, tiresome critiques leveled against Orrin Hatch (R-Utah) and Ted and precarious. This is nothKennedy (D-Mass.), who ing new for those of us who have joined in support for have stood at the bottom SCHIP expansion. end of the inequitable govSerious students of health ernment-supported health policy, however, can finally care system. Until recently, see the emergence of some all pediatric practices or real political and surgical health systems have had to leaders. In every sense for live with minor fractions of pediatric surgeons, children payment derived from Medwere meant to be seen and icaid programs and SCHIP. BY THOMAS F. TRACY not heard. The silence has Pediatric surgeons have JR, M.D., M.S. now been broken by imporbeen waiting patiently for responsible, unified professional advo- tant key events coinciding in this year of cacy aimed at fair health care funding contentious SCHIP debate. The American College of Surgeons for America’s children. Always supported by the American Academy of has worked tirelessly, as it should have, Pediatrics and recently enjoined by the on behalf of adult-focused practitioners American Medical Association, many of concerned about the economic and pous sense that the realities of health care litical challenges of Medicare. The ACS for children and poor families, in the now has every opportunity and must face of record national wealth, make have every intention to complete the tripediatric surgical specialists have Throughout this summer, had their hearts soar and dip with the ups and umvirate of advocacy for all patients to ensure the delivery of pediatric surgical care. Earlier this year, the American Surgical Association was told by its president Dr. Jay Grosfeld that our current funding levels for children may be no better than those of the third world. This came as news to no one. But if it is all that obvious, count the number of times the ACS Bulletin has informed us of resources directed at Medicaid funding and policy. Those subtle omissions surely prompted at least some of Dr. Grosfeld’s desire to jolt surgical leadership. Ninety-seven percent of American Pediatric Surgical Association members are Fellows of the College. APSA members such as Dr. Marshall Schwartz have worked as leaders of the College’s Advisory Council for Pediatric Surgery to push the ACS health policy initiative. Regent Tom Whalen has asked the ACS leadership for Medicaid and SCHIP support, pressing for expanded strategic recognition and constant review. APSA has completed a massive strategic plan under Dr. Pat Donahoe, president of APSA and a member of the Institute of Medicine, to define APSA’s longstanding responsibility for advocacy and to establish equal support from the ACS. In turn, ACS Executive Director Thomas Russell has committed the ACS to pediatric surgical specialty care, acknowledging the College’s responsibility to demonstrate to our leaders in Washington the surgical needs of children. Amid the machinations of legislative reconciliation and veto threats, pediatric surgery has had an important year. The same power and unity of purpose we have as physicians and surgeons will not let this problem fall outside our health policy scope. With ACS and APSA funding, our first Health Policy Scholars will be new symbols of this collective accomplishment and resolve. In the meantime, all should stand together to fund children’s health. DR. TRACY is pediatric surgeon in chief at Hasbro Children’s Hospital in Providence, R.I.
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