Paul Viviano: The Senate should reject the Better Care Reconciliation Act
The measure would leave our most vulnerable population -- our children -- at great risk
Editor’s Note: Paul Viviano is the president and chief executive officer of the Children’s Hospital Los Angeles. The views expressed in this commentary are his own.
Generosity, kindness and compassion are principles we ought to embrace, both as Americans and as human beings. President Donald Trump has urged Congress to send him a health care bill that reflects these values.
But, today – at least in our political world – compassion seems to be something people must earn. Nothing demonstrates this more vividly than the “Better Care Reconciliation Act” or BCRA. If Senators pass the Republican alternative to the Affordable Care Act, the most vulnerable among us – our children – will not receive “better care.” In many cases, they will receive no care at all; in some cases, they could die.
Republican Sen. Bill Cassidy, a doctor from Louisiana, said the Senate version of the health bill needs to pass “the Jimmy Kimmel test”– that no family should be denied medical care, emergency or otherwise, because they can’t afford it. The bill does not do that, at least not entirely.
Since the vote on the proposed law has been delayed, now is the time to start from scratch with Republicans and Democrats coming together to find a solution that protects our nation’s youth and does not threaten Medicaid coverage for the more than 30 million children and their families currently enrolled.
If you have forgotten why Jimmy Kimmel’s story touched so many lives, here is a refresher. Earlier this year, the late-night talk show host came to Children’s Hospital Los Angeles (CHLA) when his newborn son needed emergency open-heart surgery. A few days after the successful procedure, Kimmel shared his heartfelt story in front of a national audience, sounding less like a comedian in a monologue and more like a relieved, exhausted and grateful parent.
He ended with a direct appeal to those considering overhauling the nation’s health care laws: “If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make,” Kimmel said.
Congress needs to remember that children represent nearly half of all Medicaid beneficiaries – and will be one of the groups hardest hit by the BCRA. Challenge your colleagues to do better: Don’t accept a 142-page bill that only references children eight times. (Six of the references are merely legal definitions). Put children first.
The only direct consideration for children in the bill is a focus on blind and disabled youth. While this is a population deserving of coverage, it neglects more than 95% of children in Medicaid and in the states-administered Children’s Health Insurance Program, which provides low-cost health coverage to children in families that earn too much for Medicaid and who also face a loss or reduction of coverage.
That’s 19 out of 20 needy children now being put at risk as a result of the proposed law.
Every day at CHLA, we witness how access to clinically excellent, compassionate care for all children results in recovery and successful management of the most complicated health conditions that children endure. Having health care coverage makes a huge, tangible difference.
In contrast, BCRA was drafted by only a few members of the US Senate, in a surprisingly closed-door manner, with little or no input from stakeholders closest to the beneficiaries of the nation’s current health care system – doctors, nurses, hospital leaders, insurance carriers, the pharmaceutical industry and, most importantly, patients and families.
According to Mathematica Policy Research, a non-partisan, academic think tank, uninsured children are 70% less likely to get routine or emergency care. They also are less likely to get treatment for chronic conditions such as diabetes and asthma. Hospitalized, uninsured children are at greater risk of dying than children with insurance. And children with limited access to treatment also miss more days of school – impacting their path to productive adulthood – and affecting the future of the American economy.
Children like Cristian Mendoza, survived leukemia, in part, because he was covered by Medi-Cal, California’s version of Medicaid. Mendoza now worries about the uncertainty of what kind of coverage might be available to him when he transitions to adult care and pursues his career dream to fight childhood cancer.
“I want to become a pediatric oncologist, and that’s something that’s very expensive to do,” says Cristian, who wonders if he would be able to afford private insurance if he is ineligible for Medi-Cal.
“As a cancer survivor, I have faced and may continue to face longer-term effects on my health, but the idea of not having access to the specialist that I require like my oncologist and cardiologist is very worrisome to not only myself, but also to my friends who are also cancer survivors.”
And, yes, conservatives would argue the BCRA shrinks an expensive government entitlement (Medicaid), but it also provides substantial tax breaks to America’s wealthiest citizens with little consideration to the devastating effects this could have on children’s health.
According to the Congressional Budget Office, the long-term burden of these cuts falls disproportionately on the poorest and least healthy members of our society, who will face higher deductibles and a lower chance of coverage. This includes children with medically complex diseases like diabetes, cystic fibrosis, heart disease and cancer.
How is this generous, kind or compassionate?
At CHLA, we believe Medicaid funding for children’s health care must be maintained, not cut, capped or block-granted.
We believe children are entitled to health care provisions to protect pediatric-specific benefits providing medically necessary care determined by a child’s physician.
And we believe coverage for families matters. Children don’t live in isolation; when parents are insured, their children are more likely to get the health care they need.
We should not and cannot force millions of families to choose between obtaining health care when they are sick or putting food on the table. We urge the Senate to reject this bill and unite to develop a plan that does not imperil child health. Those who vote yes put more than 30 million children at risk for poorer health outcomes and diminish their ability to live full and prosperous lives. There is no better investment of time or money than making sure any plan voted on keeps kids covered.
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We can’t keep health care from being complicated, but we can certainly stop it from being heartless. Let’s show just how much generosity, kindness and compassion America has by preserving Medicaid coverage for children.
That’s the true Jimmy Kimmel test.