Some thoughts on health care reform

According to the latest NBC News/Wall Street Journal poll, President Obama’s approval rating is less than 50% for the first time in his presidency.

A political debate is not something we wish to begin here, but speculation is that this drop in his approval is based, in part, on opinions that he is spending too much time working on health care reform.

We disagree.

The impact health care reform will have on Cincinnati Children’s (and the rest of the country, for that matter) is hard to predict. At this point, we’re watching four major issues that will have a dramatic positive or negative impact on us if they’re part of the final bill:

1. Children in households with income more than 150 percent of the federal poverty level will move to the so-called “insurance exchange.” If this occurs, about 20 percent of the current Ohio Medicaid population under the age of 19 would go to the exchange. Cincinnati Children’s would be able to negotiate private payment rates for this population of children. These rates would be better than current Medicaid rates and would help Cincinnati Children’s off set current Medicaid losses.  Positive

2. All physicians performing evaluation and management procedures on pediatric patients under the age of 19 who are on Medicaid will receive Medicare rates for those procedures beginning in 2012. Positive

3. CCHMC currently receives an extra payment every year because the number of Medicaid patients we serve is disproportionately high. This same pot of dollars funds uninsured adults. Because there will be fewer uninsured adults, Congress proposes cutting this pot of funds.  Negative

4. Nationwide, Medicaid is going to be under a lot more stress and strain in every state than it is today. Every state will be forced to add uninsured adults to its Medicaid caseloads.  The feds will be paying 90 percent of this new cost, but it will still cause significant stress on state Medicaid roles and budgets because this population of uninsured adults is very expensive. More stress on Ohio and Kentucky’s Medicaid budgets will almost certainly lead to additional provider taxes or provider rate cuts.  Negative

We’ll wait to see how each of these issues plays out.

In the meantime, let’s talk about the changes that families might see as part of health reform.

My 18-year-old cousin has a liver disease. At this point, she’s probably uninsurable on a private plan due to her pre-existing condition. That would no longer be an issue. Insurance companies would no longer be able to deny a claim on these grounds.

Infants who spend the first several months of their lives in neonatal intensive care units are often reaching their lifetime maximum insurance benefits before they’re even a year old. Luckily, lifetime maximums would be a thing of the past.

Current Medicaid patients in households with incomes over 150 percent of the federal poverty level would be included in the health insurance exchange under the proposed reform bills. This would give those families options to see practitioners closer to their homes instead of traveling to the hospital where their Medicaid cards are accepted.

These are only a few of the pieces of these bills that we’re watching — each bill is currently around 2,000 pages. And, while it’s reasonable that Americans want our president to focus on job creation and the economy, we are pleased that he is dedicated to fleshing this out in a timely manner.

Health care reform is a moving target. The full Senate is expected to vote any day now. Then it’s off to conference committee for the House and Senate to work out a compromise.

We’ll keep an eye on it.

Kate Setter

About the Author: Kate Setter

Kate manages social media at Cincinnati Children's, a role that she loves because it gives her opportunities to help families find stories and pediatric health information that they want and need. Kate is the mother of a four year-old and a toddler, you will probably hear about them and their antics from time to time as well.

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