The Changing Health Care System
As
you are all aware, health care is in flux. All the pieces of the
children's health care puzzle at both the federal and the state levels
are moving in all dimensions. Working in this environment, as all of us
are, is similar to playing three dimensional chess, knowing that the
rules will keep changing. Thus, it is important for us to stay focused
on the goal of improving child health.
At
the federal level there are the ongoing complexities of the ACA, the
federal health care reform act. The development of Health Exchanges, the
designs of alternative networks, like ACO's, multifaceted delivery
networks, care management entities, mergers of large hospitals and even
larger health insurer corporations create unknown challenges. Even
the very survival of the reform bill itself is in doubt. All the
pieces are moving on various levels. But, there is also the significant
federal budget deficit and the ongoing debate about federal cuts to
health care to reduce the federal deficit. Some of the proposed cuts, if
passed, will significantly cut funding for health care for children and
families. Some proposals cut payments to hospitals and to
physicians. The only sure thing in this discussion is that funds
to health care will be cut sometime within the next twelve to
twenty-four months; exactly how much and where remains unknown.
At
the state level there is the work of the Medicaid Redesign Team (MRT)
and its 10 topical work groups. This broad based stakeholder group is
providing a review of and recommendations about New York State's health
care delivery system beyond the Medicaid program. The MRT group
will be reviewing final Work Group recommendations on December 13.
The recommendations the MRT accepts from the work groups will be
forwarded to the Governor for consideration of inclusion in his 2012-13
State Budget and Program Plan for the state. And the state, like
the federal government is facing a large budget deficit. For the
state it is anticipated that the 2012-13 budget will have more than a
$3.5 billion budget deficit.
As
pediatricians, it is important that we recognize the changing world we
are working in, and participate as appropriate in reform initiatives.
But it is also imperative that we remain a strong and constant voice for
children's health and well being. Our commitment to a
comprehensive children's health care benefit package modeled on the AAP
Bright Futures program must be unfailing during these challenging times.
But we can and must carry the banner for children's health and well
being in the areas of:
- social-emotional health and family support
because all children need a nurturing and supportive family;
- high quality child care, early care and
education so they can learn and thrive intellectually;
- economic security because no child can
thrive in poverty and homelessness;
- environmental health at home, in
community, in school and in child care;
- and special supports and services for our
most vulnerable children, those in foster care and the child welfare
system, the mental health and juvenile justice systems and
those who are chronically ill and medically fragile.
A Voice for Children & Pediatricians
I
do understand that for us to be a voice for children, we must also
be a voice for pediatrics and for pediatricians, because we are the
people who care for children, all children, from the most privileged
to the most disadvantaged. And during this time of challenges,
we must find the opportunities to maximize support for children and
the services and supports they need to grow up healthy and strong.
This also necessitates strong partnerships outside of pediatrics in
support of the systems of care for the transitions to adulthood for
our children, support of health promotion of adults, families and
communities essential to the well-being of children.
Please
join me in these important struggles. Our job is to articulate
the needs of children and define how best to meet those needs so
each child can reach her/his optimal level of health and well-
being. The federal and state challenges to children's health are
real and we must navigate well to not harm children in the process.
We must be fully engaged in the critical policies and
decisions that impact children's health and, despite financial
difficulties, never renege on commitments made to children and to
those of us who care about and for them.
As
we join hands in our work for children, I want to take this
opportunity to wish you and your loved ones a very happy, safe and
healthy holiday season.
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