With All Our Might...Elevating Child Health Policy

What the President DIDN'T Say in the State of the Union

Every news outlet has some variation on “top five takeaways from the State of the Union,” mostly dealing with the President’s main points of economic recovery, education, immigration, and tightening of gun laws. He made some great points: saying he will work “with states to make high-quality preschool available to every child in America,” the idea of a “college scorecard” to determine the cost-to-value ratio for colleges, and of course “what I’ve said tonight matters little if we don’t come together to protect our most precious resource – our children.”

Obama was speaking about the importance of curbing gun violence which is, no doubt, highly important. What the President didn’t discuss during the State of the Union – or even mention for that matter – was Medicaid.

You can take an optimistic or pessimistic view on this oversight. On the one hand, not mentioning the program means the President isn’t thinking about it in his 2013 priorities and not bringing it up could imply that he didn’t want to bring attention to potential cuts. On the other (and more likely) hand, the President isn’t going to cut Medicaid but didn’t want to bring attention to the LACK of cuts to the program. Most indications point to the latter.

The next step in the in the budget process will be the President releasing his budget recommendations to Congress. It’s already assumed this will be much later than in years past, possibly as late as March. At that point we’ll have a better sense of what’s in store for Medicaid as well as CHGME funding. After that, Rep. Paul Ryan (R-WI), chair of the House Budget Committee, will release his budget, which will no doubt suggest extensive Medicaid cuts as well as proposals to convert the program to block grants. But, as we wrote last year, that budget will pass the House but die in the Senate. In addition, for the first time in several years, the Senate is expected to also pass their own budget, which as it will be written by Democrats (as opposed to simply agreeing to the President’s proposal or, more often, not passing a budget at all). No doubt the Senate Democrat proposal will look decidedly different than the one the House passes – but like the House bill, has virtually no chance of becoming law.

For now, we remain vigilant and will keep our eye on the President’s budget. Next month is “Medicaid Matters” month and we’ll providing much more information on ways that you can get involved, and illustrate to Congress the important role that Medicaid plays in the health of the nation’s children.

There IS A Doctor in the House - 17, in Fact

Members of Congress come from all sorts of backgrounds. Many have “day jobs” you might expect (there are 128 lawyers in the House of Representatives, and nearly half of all Senators – 45 – cite lawyer as a profession) but others have jobs that may come as a surprise. There are youth camp supervisors, carpenters, a mill supervisor, and 15 farmers.

There are also 20 legislators that identify themselves as physicians – 16 in the House, three in the Senate and one delegate (a non-voting member of the House). Here’s a closer look at the legislators that taken time away from healing people in order to represent them in Washington.

Sen. John Barrasso (R-WY): Elected in 2006, Barrasso’s medical career prior to the Senate was certainly unique. In addition to being a full-time orthopedic surgeon, he also served as President of the Wyoming Medical Society, medical director of the Wyoming Health Fairs, President of the National Association of Physician Broadcasters, and served as a “rodeo physician” for the Professional Rodeo Cowboys Association.

Rep. Dan Benishek (R-1^st Michigan): Benishek, a general surgeon, narrowly won a second term in November. A graduate of Wayne State Medical School, Benishek completed a family practice internship in Flint, MI, before opening a private practice in Iron Mountain, in the state’s Upper Peninsula. He “semi-retired” in 2009 to run his campaign.

Rep. Amerish “Ami” Bera (D-7^th California): Dr. Bera was a general practitioner before serving as Chief Medical Officer of Sacramento County, then a Clinical Professor of Medicine and Associate Dean for Admission and Outreach at UC Davis. He ran for Congress unsuccessfully in 2010, firmly supporting the Affordable Care Act and universal health coverage throughout his campaign. He touted the same policies in 2012 and this time was successful.

Rep. Charles Boustany (R-3^rd Louisiana): Boustany was a practicing cardiothoracic surgeon for 20 years – 16 of those in private practice – before arthritis caused him to stop practicing. He maintains a medical license in Louisiana, and received the American Hospital Association’s Health Care Champion Award in 2012.

Rep. Paul Broun (R-10^th Georgia): Broun served in the military before becoming a general practitioner, first as a jet engine mechanic in the Marine Corps Reserves, then as a medical officer in the Navy. Dr. Broun also served as an emergency department physician. Now in his third term, Dr. Broun received permission from the House Ethics Committee to continue to see patients in his home state.

Rep. Michael Burgess (R-26^th Texas): Burgess was elected in 2002 after spending 25 years as a practicing Ob/Gyn in North Texas. He graduated with both an undergraduate and a Masters degree from North Texas State University (now the University of North Texas). He then received his M.D. from the University of Texas Medical School in Houston and completed his residency programs at Parkland Hospital in Dallas. In 2009, Burgess founded, and currently serves as Chairman of the Congressional Health Care Caucus.

Rep. Larry Buschon (R-8^th Indiana): Now in his second term, Bucshon was a cardiothoracic surgeon before being elected. An Illinois native who spent time in any number of Midwestern states, Bucshon completed his residency at the Medical College of Wisconsin, and eventually went into private practice in Kansas. He then became President of Ohio Valley HeartCare, and Chief of Cardiothoracic Surgery and Medical Director of the open heart recovery intensive care unit at St. Mary’s Hospital in Boonville, Indiana.

Rep. Bill Cassidy (R-6^th Louisiana): Cassidy had a cancer scare at just 16 years old. While he was eventually found to be cancer free, frequent interaction with doctors decided that he wanted to become one himself. He attended medical school at Louisiana State University, followed by a residency at the University of Southern California. He returned to his home state to take a professor position at LSU Medical School. He continues to treat uninsured patients at a Baton Rouge safety net hospital

Del. Donna Christensen (D-Delegate, U.S. Virgin Islands): Dr. Christensen earned her M.D. from George Washington University in 1970, and began her medical career in the Virgin Islands in 1975. She worked as an emergency room physician before serving as staff physician, staff physician for a maternity ward, and finally medical director of the St. Croix Hospital. She was later acting Commissioner of Health for the Virgin Islands. She maintained a private practice until her election to Congress in 1996.

Sen. Tom Coburn (R-OK): Like Rep. Cassidy, Tom Coburn was inspired to go into medicine by something that happened to him at a young age; in this case, an eye condition. He joined the family ophthalmology business, but eventually went to medical school and a returned to his hometown of Muskogee to practice family medicine and obstetrics.  If Coburn sticks to the script, he will be out of public service in 2016; he has set self-imposed term limits on both his House and Senate career, but has not indicated if he will resume his medical career.

Rep. Scott DesJarlais (R-4^th Tennessee): DesJarlais was a family physician working in Jasper, Tennessee. In the mid-2000s he noticed that his conversations with patients had turned from fishing and sports to health care and insurance coverage, and when the Affordable Care Act was introduced he decided to run for Congress. His 2010 race against incumbent Democrat Lincoln Davis received nationwide attention for vicious attack ads from both sides. DesJarlais won that race and was reelected in 2012, but has since found himself in hot water.

Rep. John Fleming (R-4^th Louisiana): Now in his third term, Fleming is one of two doctors who represent Louisiana. After earning his medical degree, Fleming became a chief resident of family medicine at the Naval Regional Medical Center at Camp Pendleton, California, and trained at the drug and alcohol treatment unit at the Navy Regional Medical Center in Long Beach, California. He has since penned a book for parents on how to keep their children away from drugs and alcohol. Following his residency Fleming stayed in the Navy to practice family medicine in Guam, and eventually established a practice in Minden, Louisiana. In 2007, the Louisiana Academy of Family Physicians named him the Louisiana Family Doctor of the Year.

Rep. Phil Gingrey (R-11^th Georgia): Dr. Gingrey is the rare physician on this list that was born, went to school, and practiced in the same state. The Augusta native attended the Medical College of Georgia, completed his internship at Grady Memorial Hospital in Atlanta, and then returned to the Medical College of Georgia for his residency. Gingrey set up an OB-GYN practice in Marietta, and practiced for 30 years before being elected to his first term in Congress in 2002.

Rep. Andy Harris (R-1^st Maryland): The son of a Hungarian anesthesiologist, Harris followed in his father’s footsteps, earning his M.D. from The Johns Hopkins University before serving in the Navy Medical Corps and the Naval Reserve.  He became a practicing anesthesiologist and eventually returned to Johns Hopkins as both faculty and staff, serving as Associate Professor of Anesthesiology and Critical Care Medicine and as Chief of Obstetric Anesthesiology. He also served as Commanding officer for the Johns Hopkins Naval Reserve Medical Unit during Operation Desert Storm.

Rep. Joe Heck (R-3^rd Nevada): Now in his second term the former osteopathic physician has a thorough background in emergency medicine. After graduating from the Philadelphia College of Osteopathic Medicine and completing his residency at the Albert Einstein Medical Center in Philadelphia, he began his career as an ambulance attendant and member of the Las Vegas Metropolitan Police Search & Rescue team. In 1991 he received a direct commission as Captain in the Army, and began a long military career that saw him several awards and commendations. He founded a medical operations company that provided training, consulting, and operational support to law enforcement agencies, EMS, and military special operations, and from 1998 to 2003 served as the medical director of the Casualty Care Research Center of the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Rep. Jim McDermott  (D-7^th Washington): McDermott’s specialty is one that most Americans think Congress could truly use – psychiatry. A practicing psychiatrist for more than 20 years, McDermott served in the Navy and spent a great deal of time counseling returning Vietnam veterans. Last year McDermott received the Friends of Children’s Mental Health Award from the American Academy of Child and Adolescent Psychiatry. Recently his medical and legislative careers found a crossroads as Congress took up gun control debates, specifically a proposal to require mental health professionals report to authorities when they think a patient is a shooting threat.

Sen. Rand Paul (R-KY): Another son of a doctor who followed in his father’s footsteps, Paul did it in more ways than one. His father, Ron, was a doctor and Representative from Texas (and, of course, a presidential candidate).  But while the elder Paul was an OB-GYN, Rand became an ophthalmologist. After graduating from Duke University School of Medicine, Paul moved to Bowling Green, Kentucky and worked for two practices before opening his own.

Rep. Tom Price (R-6^th Georgia): Price received his M.D. from the University of Michigan and completed his Orthopedic Surgery residency at Emory University. He established an Orthopedic clinic just north of Atlanta where he practiced for 20 years. He then returned to Emory University School of Medicine as an assistant professor. Prior to his election in 2004, Price was medical director of the Orthopedic Clinic at Grady Memorial Hospital (the same hospital where his colleague Phil Gingrey completed his residency), teaching resident doctors in training.

Rep. Phil Roe (R-1^st Tennessee): Roe attended his hometown college, Austin Peay State University in Clarksville, Tennessee. He then attended the University of Tennessee College of Medicine specializing in obstetrics and, upon graduating, served two years in the Army Medical Corps. He opened a practice in Johnson City which he ran for 31 years before being elected to Congress in 2008.

Rep. Raul Ruiz (D-36^th California): Unable to pay his first college tuition bill, Ruiz persuaded local business owners to provide him with $2,500 for the bill by promising to return to the community as a physician. He kept his word – 17 years later he was an emergency room doctor, and on the way became the first Latino to earn three graduate degrees from Harvard.  In addition to practicing, he founded a pre-med mentorship program, the Future Physician Leaders program, for students from underserved communities who want to become doctors and return to their community to serve. He was elected to his first term in Congress last year.