All kids deserve equal access to health care

OlympianNovember 27, 2013 

With the flurry of news surrounding the roll out of the Affordable Care Act, it seems as though our state has emerged as a relative success. Washington’s Health Benefit Exchange (now called Washington Healthplanfinder) and the expansion of Medicaid in our state has provided many more people with access to health care.

Unfortunately, not all children in Washington have access to the same care. About half of the children in our state have health care paid for by Medicaid (Apple Health for Kids).

As pediatricians and leaders of the Washington Chapter of the American Academy of Pediatrics (WCAAP), we are greatly alarmed by the two-tiered system that exists in our state in which kids enrolled in Medicaid are not provided access to the same preventive services and screenings that the Affordable Care Act has recognized as the standard of care for kids: Bright Futures.

Bright Futures is the nationally recognized standard of preventive care for children. It was developed by the federal Health Resources Service Administration’s Maternal and Child Health Bureau in 1990 with involvement of over 30 stakeholder groups and expert panels. These guidelines have been reviewed by nearly 1,000 practitioners, educators and child health advocates throughout the United States, and were updated and revised in 2000 and 2008 to reflect current scientific knowledge and best practices.

Under the Affordable Care Act, new private plans (including those on Washington’s Health Benefit Exchange) are required to cover Bright Futures preventive services for infants, children and adolescents; most private plans in Washington and a majority of Medicaid plans in other states already cover the Bright Futures guidelines. Apple Health for Kids does not.

The result of this disparity is that our Medicaid-enrolled patients do not have access to the same well-child visits and developmental, autism and mental health screenings and visits that other children in our state receive. These visits are a critical opportunity to detect developmental delays, connect children to early intervention services and keep children up to date on their immunizations.

These visits give pediatricians a chance to provide anticipatory guidance about safety, nutrition, behavioral and mental health and catch health problems at their earliest manifestation.

Currently 8.3 percent of children on Medicaid have fair to poor health compared to 1.1 percent of children with private commercial insurance. Our Medicaid patients truly benefit from these extra preventive care visits where we can focus on nutrition, obesity prevention, chronic health issues like asthma, and dental and mental health. These disparities in coverage impact our youngest children and teenagers where we have the most opportunity for lifespan health impacts and cost savings if our care is done right.

The WCAAP believes that all children in our state deserve access to the same standard of care. The state’s Health Care Authority has recommended that Gov. Jay Inslee include full coverage of the Bright Futures standard of pediatric preventive care in his 2014 budget.

We urge him to heed that recommendation.

Beth Harvey, MD, FAAP, is medical director of South Sound Pediatric Associates, of Olympia, and past-president of the Washington Chapter of the American Academy of Pediatrics. Rupin Thakkar, MD, FAAP, is medical director of the Swedish Children’s Clinic, of Edmonds, and trustee of the WCAAP.

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