(Editor's Note: John Bouman is the President of the Shriver Center. He is recognized for being one of the most effective and thoughtful public-benefit advocates in the country. Say Ahhh! asked him for his thoughts on national health reform.)
We all worry about our children so of course we are concerned about the treatment of children in health reform. There is worry about the House bill's ultimate elimination of the CHIP program and switch of covered children into either Medicaid or "the exchange". The exchange is said to be too uncertain, because premiums and co-payments could be too high and result in families not buying coverage, which could then result in the family's children becoming uninsured.
Those are legitimate concerns and worthy of the strong advocacy they are getting. Children's advocates have worked hard to preserve the CHIP program at least until the "exchange" plans prove themselves as vehicles for children's coverage. But it is also important to work to achieve the best possible affordability of insurance in the exchange. Arguably, it is the higher priority.
The best way for a child to be healthy is for the child to be part of healthy family. If the parents understand prevention and early treatment, and pursue their own health, the children are much more likely to be on that course themselves. For children to be healthy, they not only need coverage, but they need to be enrolled, connected to a doctor, and then actually conveyed to the doctor at the right time by their parents (or other caregivers), which is much more likely if the parents are healthy and focused on their own healthcare.
So the top option for a health system, from the children's point of view, is a system that serves families well, prompts
smart healthcare behavior by the adults, and maximizes family health.
If we can't have that, then the fallback is a system that at least does
what it can to serve the children. That's the current U.S. system as it
applies to low and moderate- income families. We fail the parents and
young adults, but we do what we can through Medicaid and CHIP to help the
children and a few adults. Because the system, by failing to cover
adults, blocks most of them from establishing a medical home and pursuing the
smartest health care possible, their children are denied the chance to live in
a healthy family and thus denied the best chance to be healthy themselves.
Because we have a fallback system, recently improved through CHIPRA, the
children still have a chance for a healthy life, but it's a second best chance.
The best way to achieve children's health is through whole family health. Children's advocates should not leave advocating for a strong exchange to other health care advocates. A strong and affordable exchange should be the first priority for children because it includes the whole family, which is the healthiest situation for children. The children's groups should be leaders in support of the affordability of exchange policies, even as we continue to fight hard to make sure that CHIP is there for kids who need it.
The views expressed by Guest Bloggers do not necessarily reflect the views of the Center for Children and Families.
The discussion about what should be one's top priority in any policy discussion is always a difficult one. In deciding what to make a priority, groups with few resources and limited political clout must weigh a lot of options: (1) what is most important to the group they advocacy for; (2) what can they really influence in the legislative process; and thereby, (3) where is the most "bang-for-the-buck."
First, it is critically important to note that children's groups have all made improving the affordability of coverage in the exchange one of their priorities. Some have even made it their top priority. However, it seems Mr. Bouman is taking issue that some children's advocacy groups have made the exchange their second or third priority rather than first and, on that point, Mr. Bouman misses a critical reality.
As children's groups sought to measure what they can really influence, the evidence is pretty overwhelming that advocacy pushed by hundreds of groups to make the exchange more affordable through 2009 has been anything but successful. In fact, groups far more powerful and influential before Congress, including AARP, the American Cancer Society, the American Heart Association, the AFL-CIO, and SEIU have been completely unable to move the dial and make the exchange plans more affordable due to the limitation that all spending within the legislation must be offset with other spending cuts or increases in taxes.
In fact, as we begin 2010, the deal that Congress just made with labor to reduce the excise tax will cost $60 billion and, by definition, just reduced the affordability in the exchange even more.
In light of those realities, it is virtually impossible to see how the children's groups could completely change the debate by moving affordability in the exchange up on their list from second or third to first will actually be the tipping point that makes the critical difference whereby Congress would find billions of dollars to make the exchange more affordable.
In fact, groups like Families USA have made affordability in the exchange their top priority. Meanwhile, AARP was pushing to improve affordability in the exchange, they simultaneously got changes in the legislation to close the doughnut hole in the Medicare prescription drug benefit and to impose a 2-to-1 age band in the insurance exchange (which actually has the effect of making coverage for children and young adults LESS affordable). Furthermore, pediatric providers have made the payment issues within Medicaid their top priority.
Thus, it makes complete sense that children's advocacy groups would make CHIP their top priority. If CHIP is repealed, millions of low-income children would be left worse off in health reform and only children's advocacy groups are there to left to protect them. In short, for those millions of kids, the current priority is actually very well placed. In fact, it is not necessary for children to be left worse off in order for their parents to benefit from health reform and that fact should be paramount.