On May 1, Children’s Hospital Association CEO Mark Wietecha spoke at The Atlantic Health Care Forum in Washington, D.C., which featured speakers and panels on a range of health care topics. Below is an abridged version of his remarks that frame a discussion on the Affordable Care Act and new models of insurance that address the rising cost of health care:
The future of health care is like the ocean. We know what the surface looks like but 95 percent of the bottom is unchartered territory. Above the surface there are accountable care organizations, the coming health care Exchanges and a clear orientation to consumerism.
But below there are a host of unknowns at work. For example, will the Exchanges be like Amazon.com or sophisticated enough to change depending on population needs? Will there be continuity if a subscriber moves from one plan to another? At what level of co-pays and deductibles will patients decide to forego care?
As children’s hospitals, our job is to look at the future through the pediatric lens.
Today there are 70 million mostly healthy children in the U.S. - more than the population in some countries in Europe - and 40 percent of them are on Medicaid. That’s 30 million human beings. Millions more children are in the Children’s Health Insurance Program and millions of others will enroll in the Exchanges.
There are numerous positive health care coverage provisions in the Affordable Care Act that benefit children: The removal of pre-existing conditions as a reason for insurance denial; the removal of life-time caps; and the extension of coverage to dependent children up to age 26 are all good signs.
Most kids are healthy and we hope that they grow up wealthy and wise. However, the sickest kids - roughly 2 million children who are born with severe health care challenges or acquire them through a traumatic event – are heavily reliant on Medicaid. What does the brave new world of health care look like for this population of children with medically complex conditions?
First, they will require a range of pediatric services and specialties. A typical HMO model is not going to work for these kids who need continuity of care across providers versus tiering and annual plan changes.
Second, these families travel across state lines to regional care providers for services. As a state-by-state program, Medicaid in its current structure can be onerous, and preventative-oriented Medicaid managed care plans are not the right fit for these kids.
A solution the children’s hospitals and the Association are exploring involves national networks of accountable care for medically complex children to ensure continuity across state lines, establish quality measures and collect data on this population into a national database in order to continually improve on that care.
As a matter of economics, the Affordable Care Act is heavily focused on adults in the health care system. However, we cannot let kids slip through the cracks, especially the most vulnerable among us.