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Children are left out

Health-care reform must provide for the special needs of kids. And it should start with Medicaid.

By Steven M. Altschuler

The national debate on health care, which has raised many issues from insurance to quality to costs, has said nothing about children, who need reform just as much as adults do.

Many assume that reforms for adults translate into reforms for children, but that is wrong. Children are not small adults. They have different health-care needs and a separate system of care, from primary-care pediatricians to specialized children's hospitals. Children also face a unique set of issues that should be addressed in health-care reform.

Like adults, children's health-care issues include insurance, access to medical care, and a shortage of specialists. But children's health care is not equal to the adult system of care, a problem all current reform proposals ignore. It begins with Medicaid.

Created as an insurance system for the poor, Medicaid has grown into the safety net insurance system for children. Almost 30 percent of the nation's children are insured through Medicaid or through the state Children's Health Insurance Program, which expands Medicaid to cover children above the poverty level.

As state revenues plummeted this year, many states were forced to cut Medicaid programs or cut back eligibility, which disrupted care for children. California, for example, nearly cut 450,000 children from Medicaid programs until lawmakers saved the program at the last minute.

Medicaid also pays physicians and hospitals substantially less than Medicare, the federal government insurance for senior citizens. For comparable services, Medicaid often pays doctors and hospitals up to 30 percent less than Medicare. Many pediatricians cannot afford to accept Medicaid and some children's hospitals face bankruptcy because they treat high numbers of Medicaid patients.

It is an unfortunate fact that insurance does not guarantee access to care. Many private insurance companies, to hold down costs, refuse to contract with specialized children's health programs. So, parents must pay many medical costs for their children themselves even though they have insurance.

When they receive approval to see a pediatric subspecialist, children often must wait months or even a year for an appointment, especially in programs like autism or neurology, because of the doctor shortage. The inequities between Medicaid and Medicare contribute to the shortages. Medicare pays some of the costs necessary to train doctors for adults. Medicaid pays nothing to train doctors for children.

To encourage more people to become physicians and reduce shortages, scholarships, loan forgiveness, and increased physician reimbursement are all on the table in health-care reform proposals. But that is only for physicians who would treat adults, not children. We must provide the same incentives to pediatric specialists that we do for physicians who care for adults to eliminate shortages and open doors to treatment.

For health-care reform to serve all of us it must tackle the inequities between the care we provide children and adults. Insurance carriers must allow universal access to specialized care. Government insurance must be changed to stabilize funding for children and pay physicians and hospitals a fair rate whether the patient is a child or a senior citizen.

It would be a tragedy if our nation fundamentally reformed health care and forgot about our children. The consequences would be fewer pediatricians, fewer children's hospitals, and increased waits for specialized services. Ultimately, without reforms, the care our children receive will be worse than the care received by their parents.