With All Our Might...Elevating Child Health Policy

Same Goal, Different Approaches

By guest blogger, Larry McAndrews, N.A.C.H. President & CEO

The goal of improving the nation’s health care delivery system is the focus of all, even as the continuing debate in Washington shows us that the approaches of how to achieve this are different. I was invited to lunch yesterday with HHS Secretary Kathleen Sebelius, CMS Director Donald Berwick and their staffs to discuss the issues now being debated on Capitol Hill. I was joined by leaders of the American Hospital Association, the Federation of American Hospitals, the National Association of Public Hospitals, the Catholic Health Association and the Association of American Medical Colleges. We have promised to continue our dialogue on a regular basis.

The conversation reminded me of all the positive provisions now contained in the law:

• preventing insurers from denying coverage to children with pre-existing conditions and removing annual and lifetime caps on children’s coverage
• extending authority and funding of CHIP
• starting to address access for children by reducing Medicaid payment disparities by requiring Medicaid pay at least Medicare rates for primary care physician services, including pediatric medicine, for two years
• creating opportunity for Medicaid reforms, including new payment models such as pediatric ACOs, medical homes and other innovations through the newly created Innovation Center

In addition to the advance that children’s hospitals have achieved, much work remains ahead. For example:

• Medicaid reimbursement remains 30 percent less than Medicare for the same services
• DSH must be kept in place until Medicaid payments cover the cost of care
• Access to specialty care will remain a challenge if economic incentives that support pediatric specialists are reduced or eliminated

Children’s hospitals are well positioned to be at the forefront of efforts to achieve these and other policy goals. As essential regional providers and integrated delivery systems, children’s hospitals will continue to be national leaders on improving quality of care, expanding access and providing value. We must continue to lead so that the nation’s children--who are our future--enjoy the benefits of a health care system that leads the world in cost efficiency, quality of care and compassion.

 

New England Advocates Share Successful Strategies for Growing Children's Coverage

By Eugene Lewit, The David and Lucile Packard Foundation

A new report by the New England Alliance for Children Health (NEACH) tells an impressive advocacy success story. More importantly, it draws practical ideas from the advocates who made it happen, serving as a guide to advocacy strategies that work.

The uninsurance rate for children in the United States is at the lowest level ever despite continued deterioration of employer-sponsored insurance and a very weak economy. The gains in children's coverage have been due in large part to actions taken by states to expand eligibility for and cut the red tape in their Medicaid and CHIP programs. The New England states (Connecticut, Rhode Island, Massachusetts, New Hampshire, Vermont, and Maine) have led the nation in covering uninsured children. The rate of uninsurance among New England's children is half the national rate (9.3%) and all 6 New England states rank in the top 10 for the lowest child uninsurance rates.

New England advocates played important roles in spurring and supporting progress in their states. These organizations are likely to continue to be important players in the implementation of CHIPRA and broader health care reform. Insuring New England's Children: An Advocacy Success Story a newly released publication from NEACH, an initiative of Community Catalyst, examines how state-based advocates in the New England states have been successful in working to ensure that each state provides its children with high-quality, affordable health coverage.

To compile the report, NEACH staff conducted 35 interviews with individuals from the 6 New England states that work on children's health care. The interviews showed that advocates from across the region employ similar strategies to achieve gains in children's health coverage. The strategies include: assembling a core group of dedicated advocates and building a coalition; collecting personal stories and data; fostering champions in state government; focusing on coverage, not coverage policy; not giving up when the going gets tough; and reaping the benefits of regional collaboration.

NEACH's findings may seem familiar to those of you in the child health policy community. My colleague Liane Wong and I wrote this past summer about issue briefs from the on-going evaluation of the David and Lucile Packard Foundation's Insuring America's Children: States Leading the Way (IAC) grantmaking strategy, which highlighted similar strategies. Both independently conducted studies emphasize the importance of coalition-building, fostering champions, and using credible data as central components of successful child health advocacy. Even the NEACH publication's last lesson--that regional collaboration can enhance efforts underway in individual states by generating economies of scale and promoting cross-state learning and communication--is reflected in the way that the IAC work uses Georgetown University's Center for Children and Families and Spitfire Strategies to promote cross-state learning and communication.

Thus the new NEACH report provides additional evidence validating many of the advocacy strategies and tactical innovations employed by veteran advocates throughout the country. Importantly, it also reminds us of the value of learning from and in turn supporting others working to obtain similar goals in different venues. Those eager to strengthen their advocacy efforts can take it as a guide to practical and field-tested ideas for ways to accelerate the pace of change.

This post was originally published on Jan. 3, 2011 in Georgetown University's Center for Children and Families' Say Ahhh! A Children's Health Policy Blog. Children's Hospital Boston, Children's Hospital at Dartmouth Dartmouth-Hitchcock Medical Center, Connecticut Children's Medical Center and Yale-New Haven Children's Hospital have been involved in NEACH efforts to expand health coverage to all children in New England.