With All Our Might...Elevating Child Health Policy

Children’s Hospital Days at HHS

This week, over 130 children’s hospital representatives were in town for N.A.C.H.’s VIP Advocacy Day. This year in addition to going to Capitol Hill, many children’s hospitals participated in meetings with high level officials at the Department of Health and Human Services (HHS) to discuss priority children’s health policy issues. Many of these meetings focused on particular aspects of health reform and how we can partner to ensure that implementation works for children.

Thank you to all of the children’s hospitals that participated in these meetings and contributed significantly to the success. We could not have done it without you.

As the person responsible for arranging these meetings, I am happy to say that we secured six of the seven meetings that we requested. We even had an extra meeting with White House policy staff working on health reform. It was a little nerve racking to be calling it “Children’s Hospital Day at HHS” even before any meetings were confirmed. With multiple meetings spanning three days, we ended up with “Children’s Hospital Day(s) at HHS.” Now I will be able to sleep a little better…

The main focus of these meetings was to not only build stronger relationships with HHS staff, but also to establish ourselves as a community that can contribute positively to policies for children. In every meeting, children’s hospitals provided their feedback on what works for children, related to access to care, health information technology, childhood obesity, health insurance exchanges, Medicaid delivery system reforms and program integrity. Here is a rundown of the meetings that children’s hospitals participated in:

• HHS Secretary Kathleen Sebelius
• David Blumenthal, MD, National Coordinator for Health Information Technology
• Surgeon General Regina Benjamin, MD
• Jay Angoff, Director of HHS’ Office of Consumer Information and Private Insurance Oversight
• Peter Budetti, MD, CMS Deputy Administrator for Program Integrity
• White House Domestic Policy Council staff
• White House Office of Health Reform staff and Health Policy staff from the Office of Management and Budget

Ever since the meetings concluded yesterday, we have begun to outline follow up items and next steps to continue the momentum we have on these issues. As a fellow staff member said to me after the last meeting concluded, “Now the real work begins.”

Christopher Durovich, President & CEO, Children’s Medical Center Dallas; Michael Farrell, President & CEO, Rainbow Babies and Children’s Hospital; David Ludwig, M.D., Ph.D., Director, Optimal Weight for Life (OWL) Clinic, Children’s Hospital Boston ; Sandy Hassink, MD, FAAP, Director of Obesity Initiatives; Nemours and Suzanne Respess, Director, Government Relations, The Children's Hospital of Alabama are photographed with Surgeon General Regina Benjamin, MD after a successful meeting. Photograph courtsey of N.A.C.H.

Stakeholders Provide Input to HHS on Health Insurance Exchanges

By Melissa James, associate director, policy analysis & implementation, N.A.C.H.

One of the major mechanisms for expanding health care coverage under the new health reform law will be the creation of state-based health insurance exchanges. The exchanges will begin to operate in 2014 and will essentially be marketplaces where individuals and small businesses can purchase health care coverage for themselves and their employees.

Although the exchanges will be state-based, the federal government will determine standards for some areas of exchange operations, and may even step in to operate an exchange in a state that opts not to do so itself. Earlier this week I attended a conference at the Department of Health and Human Services (HHS) related to implementation of the exchanges. The purpose of the conference was to give stakeholders a chance to provide feedback to HHS regarding specific issues it should consider as it moves forward with implementing the exchanges.

Secretary of Health and Human Services Kathleen Sebelius opened the conference by emphasizing that exchanges are actually a familiar concept, since they will be similar to how health insurance is currently offered to federal and many state employees. Secretary Sebelius also stressed that exchanges have been promoted by both political parties as a market-based approach to expanding coverage.

Next, a series of panels discussed a number of issues related to exchange implementation, including: how exchanges will meet consumer needs; how exchanges will work for small businesses; how qualified plans offered through an exchange should be designed; how the exchanges will operate; the role of the exchange in promoting quality improvement and affordability; and enrollment and eligibility. Panelists spoke to these issues on behalf of a wide variety of stakeholder interests, including consumers, small businesses, large employers, the insurance industry, providers and states.

Although the views expressed were diverse, there were some common themes that ran through the panel discussions:

• States will need to determine how active a role their exchanges will play in advancing health system reform. Options could range from simply accepting all health plans that are qualified to offer coverage through the exchange, to actively encouraging competition by choosing plans based on price and quality.
• Most individuals are not accustomed to researching and selecting their own health plans; therefore, it will be very important that consumers have access to as much information as possible to help inform their choice. Several panelists noted that consumers may tend to choose insurance based on the lowest premium, when other factors such as covered services and cost sharing for specific services may be more important in the long run.
• States need to develop some way to deal with the likelihood that individuals and families, particularly those in the lower income ranges, may “churn” between public and private health coverage, forcing them to change health plans. Suggestions included streamlined eligibility systems and encouraging insurers to offer both private and public health plans to encourage continuity.
• Choice of provider and ensuring that plans provide an adequate provider network will be critical to consumers. As individuals choose coverage, they will want to know which plans include their current providers; this will become even more important to establish consistency if individuals are forced to move between plans as their eligibility for public coverage or subsidies change.
• Strong national performance standards must be developed if exchanges and consumers are to be able to evaluate the quality of health plans and health care providers. Without such standards it will be impossible to move from volume-based to value-based care delivery.

As HHS and the states move forward with implementation, advocates for children will want to make sure that these and other issues are addressed in a way that considers the unique health care needs of children. What do you see as the most important issues for exchange implementation, and how would you suggest they be addressed?

For more information regarding the health insurance exchanges and some of the important issues for families, I recommend an issue brief recently released by the Center for Children and Families at Georgetown University.