Back in August, I wrote about serious education reform being hamstrung by our cultural, social and deeply institutionalized disregard for children. The howls of protest that column inspired came from readers who insisted I was wrong, and who countered that we do indeed cherish our children and that educating them and keeping them healthy are top priorities.
The trouble is, we don’t fully understand the connection between the two and, more significantly, we don’t put our money where our collective mouths are.
A case in point (and a sad, familiar feature of our neglect) has been inadequate Medicaid funding, specifically the portion earmarked for children’s health care needs. Educators and health care professionals have long recognized that children’s health is linked to success in the classroom. Children functioning at less than optimum health inevitably fall behind in school due to periodic or extended absences. Not surprisingly, the Centers for Disease Control and Prevention reports that the poor health/poor school performance connection is particularly acute among underprivileged children.
Ironically, the vast majority of these kids qualify for low-cost or free health care coverage through Medicaid or the state Children’s Health Insurance Program (CHIP) – two safety nets that address the importance of children’s health as the essential component of their success in the classroom and in life. By far the nation’s largest public provider of children’s health insurance, Medicaid covers all medically necessary services including physician and hospital visits, well-child care, health screenings, and vision and dental care. CHIP provides similar coverage for children who do not qualify for Medicaid but are still classified as low-income.
So all is well with children’s health, right? Hardly.
Meeting the health care needs of uninsured children, thereby keeping them healthier and in school, is yet another demonstration of our unpleasant habit of disregarding kids’ needs. The problem is twofold, starting with lack of basic awareness. According to the American Academy of Pediatrics, more than 55 percent of the nearly 173,000 uninsured children in Colorado are eligible for Medicaid or CHIP but are not enrolled because their families do not know about the availability of coverage, or do not have the emotional or practical wherewithal to access the benefits.
A more pressing issue is state and federal funding of Medicaid and CHIP. In the delirium of our current against-any-tax mania and state budgetary woes, hospitals and doctors continue to experience declining or insufficient Medicaid and/or CHIP reimbursement from the state and the feds. That means these organizations and physicians lose money every time they provide health care to a child with Medicaid or SCHIP coverage. Medicaid currently reimburses providers 72 percent of costs for outpatient cases. Sadly, the reimbursement rates for inpatient care, adjusted for diagnosis and condition, have stagnated at nearly 1996 levels.
According to the Colorado Health and Hospital Association, nearly 270,000 people were covered by Medicaid in 2004 right here in the six-county Denver metro region. Due to insufficient reimbursement rates, the hospitals that treat these patients lose money on virtually every one of them. And because Medicaid reimbursement is also low for doctors who treat children, fewer pediatric and family practices accept Medicaid patients, causing more to end up in hospitals, often in emergency rooms, for health issues that do not require expensive emergency treatment.
Once again, however, we have the opportunity to debunk the notion that children are not our priority. State Referendums C and D will allow state government to retain an estimated $3.7 billion in surplus revenue during the next five years to fund essential programs, including health care and K-12 education – two child-focused areas that readers tell me they care deeply about.
Under both referendums, 30 percent of that $3.7 billion surplus revenue, about $930 million, has been targeted for health care. Those dollars will increase the number of children and families with health insurance, facilitate their access to doctors and hospital care and thereby improve health and classroom outcomes for kids. And for those who prefer a purely bottom-line approach, countless studies have shown that investing money in children’s health and education now saves significant dollars in the long run as these children grow older.
But, then, we know all of this. After all, we insist we care deeply about children. That must be why, according to the CDC, Colorado ranks 44th in the nation in immunization rates for children.
Chuck Reyman (reyman.charles@tchden.org) is public relations director for The Children’s Hospital in Denver.
