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Commentary | VOICES / A FORUM FOR COMMUNITY ISSUES

Cuts in Medicaid Will Hurt Kids

February 15, 2003|Walter W. Noce Jr. and Larry E. Fleischmann | Walter W. Noce Jr. is president and chief executive of Childrens Hospital Los Angeles. Larry E. Fleischmann is president of Children's Hospital of Michigan.

Time heals all wounds.

That's not true, of course. For most medical conditions, ignoring symptoms and putting off treatment causes serious complications.

That's a lesson Congress must heed now. A two-decade-old program for hospitals that serve poor children came under the knife last fall as Congress let an alarming $1-billion, or 13%, cut go into effect for an important Medicaid program.

Like forgoing critical medical care, Washington's neglect is about to start hurting children. Visit any children's hospital and you'll see what's at stake. We treat the cancer patient, the child who needs an organ transplant and the victim of a serious motor vehicle crash.

But it's the less visible services that are threatened. For example, in our hospitals we have special preventive care and screening programs that detect problems early. We can provide early diagnosis for asthma and diabetes and begin treatments that keep children out of emergency rooms. We undertake immunization programs that prevent the onset of diseases and dental programs for kids with special needs. Translators play a critical role in communicating with immigrant parents about how to care for their children.

Two decades ago, Congress created a program that makes supplemental payments to hospitals that serve a large share of Medicaid or uninsured patients. Typically, Medicaid reimburses providers for only part of the cost of providing care -- now about 69% for children's hospitals -- leaving the hospital to make up the rest. These safety-net facilities, called "disproportionate share hospitals," rely heavily on the supplemental support this program provided to make up the Medicaid shortfall.

More than half of Medicaid's 40 million beneficiaries are children, nearly 80% under the age of 12. Medicaid is the nation's single largest payer of children's health care -- covering one in five children and one in four infants. Last fall's cuts to the supplemental program, now trickling down through the states, couldn't come at a worse time. Health-care costs continue to rise. The number of people who are uninsured or rely on Medicaid is growing. And most states, which must match the federal money for hospitals, are facing serious budget shortfalls.

California is one of the states hardest hit by the supplemental cuts, a one-year loss of about $174 million. And we're not alone. Public and other safety-net hospitals will suffer too. But the effect on children's hospitals is critical because we serve the youngest and most vulnerable.

Taking a big bite out of institutions that serve poor kids would be bad enough. But children's hospitals treat all kids and play an important role in the health of youngsters who are never carried through their doors. Children's hospitals train a majority of pediatric specialists. They perform cutting-edge research, and they serve as centers of excellence for the country's sickest children.

That's why the Medicaid supplemental program is the most important children's health-care issue before Congress this year. The longer Congress delays, the more children's hospitals will be pressured to curtail patient care and special programs. Washington is talking a lot about Medicare and prescription drugs for seniors. Lawmakers should not forget about those who don't have a voice -- our children.

Congress must restore Medicaid supplemental funding.

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