Jim Kaufman, NACHRI vice president, opened the Tuesday morning plenary session with a quick update on national health care reform. Kaufman then turned his thoughts towards another great challenge just behind natioanl health care reform: state funding. Right now, 28 states are reporting budget gaps of more than $1 billion. For 2010, the situation gets worse with states estimating more than $180 billion in aggregate shortfalls. With Medicaid being the largest part of state budgets, state budget shortfalls are likely to jeopardize health care reimbursement in the states.
Following Kaufman, a panel of four experts shared their perspectives, setting the stage for a lively discussion.
Rand O'Donnell, president and CEO of Children's Mercy Hospitals and Clinics in Kansas City
We've seen many changes the past 30 years in Washington; what we are seeing today is beyond what we've seen in the past, and "it's going to be shifting sands as we look into the future." Through NACHRI, we still have the Pathways program thata we need to keep in mind to help shape the discussion for the future. We have to remember that it is not just coverage that we need, but reimbursement, because when it comes to Medicaid, in most cases, we are still being reimbursed far below our costs. The Catch-22 in Medicaid equality is that both state and national governments are able to pass responsibility to one another for Medicaid reimbursement rates. One of the effects of our present course is going to be unintentional rationing, either through incredibly long wait times or scarcity of local care in certain subspecialties.
Amy Mansue, president and CEO of Children's Specialized Hospital in NJ
"Do No Harm," is the message that children's hospitals have been marching through the halls of Capitol Hill for the past two years. "No one is sitting on Capitol Hill today thinking 'how can I hurt children's hospitals?'" We have not done health care reform in the United States, not because we are bad people, but because it is complicated. Go home, find a patient story to share that puts a face to your issues.
Rich Cordova, president and CEO of Childrens Hospital Los Angeles
"Never in my career have I seen so many balls in the air that we have to juggle." Looking at California should make children's hospitals in every other state feel better about where they stand. California's credit rating is the lowest of all 50 states right now, and there is a state budget shortfall of $26 billion. The Medi-Cal program, along with every other state funded program, is experiencing budget cuts.
Bonita Stanton, MD, president Association of Medical School Pediatric Department Chairs, Inc., and pediatrician-in-chief at Children's Hospital Michigan, Detroit Medical Center.
I think I speak for pediatricians across the U.S.: we so thank NACHRI for the leadership you have taken on health care reform. Nonetheless, I feel like I speak for most pediatricians that health care reform may not improve the health of all children. So far, health care reform discussion has not been about health care, but about insurance coverage. Fact 1: Health care access remains limited for the poor and for minorities who bear the burden of a disproportionate share of morbidity and mortality. Fact 2: Medical students are graduating with huge debt, with disproportionately higher debts for historically under-represented minorities. Fact 3: Growing debt means that fewer medical students are going into lower paying primary care specialties, including pediatrics.
Panel Q&A from audience:
Q. Due to state shortfalls, have their been cuts in California's CHIP funding:?
A. (Cordova) There were about two months that we were looking at disenrolling kids from the program, but we managed to patch those holes for the time being, but we are still just trying to patch holes across the system.
Q. What does Sen. Rockefeller's amendment do to hurt children's coverage?
A. (Mansue) The greatest challenge is that the president that is trying to help us has set up some parameters that have made it very difficult to get a resolution that helps everyone. If we can't add a single dollar to the budget, it makes even well-intentioned amendments a challenge because compromises can end up hurting coverage for children.
Q. Is there a solution we can offer to Congress by looking at variations in utilization across the country?
A. (O'Donnell) When "managed care" was first proposed as an idea, it meant that we really managed care well and in a cohesive way. With good data, it is possible to have a baseline that allows us to see what is working and what isn't working. Mananged care is going to provide us with our best opportunities.
(Cordova) Hospitals that are parts of health care systems have advantages in managed care, but for those hospitals that are freestanding, there is a risk of ending up at the bottom in health care reform. Families are going to want to have everyone in the family in the same plan. There is going to be a huge challenge for freestanding hospitals to put together systems they can be a part of to help make managed care work.
(Stanton) These paradigms have to be supported by data-driven results.
Q. What is the real impact of the public option on children's hospitals?
A. (O'Donnell) If we project that the public option will protect reimbursement levels at their current percentages, then very little impact, but if those dollars are reduced for publically insured patients, it eliminates our ability to plug the hole and help take care of Medicaid and charity care.
(Mansue) The government has set up a program, DSH, to acknowledge that they underfund us. Some of the proposed programs will just succeed in moving the money around -- its a shell game -- but it doesn't address the underlying issue.
What issues and questions do you have about the national or state challenges in health care reform?
