The New York Times ran an article last week on the results of a new study published in The New England Journal of Medicine (NEJM) on access to outpatient specialty care for children on Medicaid and the Children’s Health Insurance Program (CHIP). The study found that children with public health insurance are much more likely to be denied specialty care or forced to wait for long periods of time for a specialist appointment than children with private health insurance. Medicaid and CHIP have been very successful in other important ways, but this study is concerning—particularly in the context of current proposals under discussion in Congress that would undermine these vital programs that provide a lifeline to millions of children as well as other vulnerable populations.
To conduct the study, research staff posed as parents and called specialty practices in Illinois to schedule appointments for their children. The two major findings from the study were:
- -- More than 66 percent of callers who said they had a child on Medicaid or CHIP were denied an appointment, compared to only 11 percent of callers who said they had a child on private insurance.
- -- The average wait time to see a specialist who accepted both public and private insurance was 22 days longer for Medicaid and CHIP children than for children with private insurance.
Access to specialty care for children on Medicaid and CHIP is clearly an issue that needs to be addressed. This begs the question of what effect current Congressional proposals to turn Medicaid into a block grant program, cap federal expenditures, or allow states to cut Medicaid and CHIP eligibility through repealing the Affordable Care Act’s maintenance of effort requirements (MOE) would have. The short answer is that all of these proposals would make this problem even worse. Block granting or a spending cap would result in reductions in Medicaid and CHIP spending, which would inevitably lead to provider rate cuts. Repealing the MOE provisions would result in reductions in overall coverage levels—leading to more uninsured children. Either way, these proposals would result in even less access to specialty care (not to mention to other essential health services as well).
Overall, Medicaid and CHIP serve our country’s children immensely well by providing cost-effective coverage for children that improves health outcomes and protects low-income families from financial ruin. For example, Medicaid and CHIP children actually fare very well when it comes to access to primary care. According to HHS, “Considerable evidence indicates that children enrolled in Medicaid/CHIP have much better access to primary care services than uninsured children and comparable access relative to privately insured children.”
In areas like access to specialty care, where further progress needs to be made, the answer is not to undermine these programs by reducing our investment in them. Instead, we need to implement innovative policy proposals that create savings in Medicaid by improving the health care delivery system, and that can be used to address outstanding issues like access to specialty care as well as for deficit reduction. And it’s up to all of us to make sure that members of Congress understand that we need thoughtful solutions to our nation’s problems, not mindless cuts.
—Patrick M. Tigue, Children’s Health Care Coordinator New England Alliance for Children’s Health