Proposed Medicaid Changes Would Put Medical Decisions for Kids in Hands of States Instead of Parents and Pediatricians

In a recent interview with CNN’s Jake Tapper, Secretary Price spoke about the efforts underway to change our health care system. In fact, there’s much discussion in DC these days about health care – who should have it, how much it should cost, and which benefits should be included. While there’s room for improvement on many of these fronts, there is one area where as a country we’ve done a really great job – covering kids. We reached a historic high of 95% of children with coverage in 2015, due in large part to the success of Medicaid and the Children’s Health Insurance Program (CHIP).

And for the 37 million kids in Medicaid, and almost 9 million kids in CHIP, we’ve also done a great job on making sure coverage is affordable. Federal Medicaid and CHIP laws limit cost-sharing to less than 5 percent of family income, including premiums, deductibles, copayments, and any other out-of-pocket costs, with no cost-sharing permitted for children in families with incomes below 150 percent of poverty. Most states have kept cost sharing far below the federal maximums because the research is clear – premiums and cost-sharing decrease enrollment and cause enrollees to delay needed care.

Secretary Price spoke about the proposed changes to Medicaid in the American Health Care Act (AHCA), which we’ve blogged about here and here. He advocated for a system whereby doctors make medical decisions rather than having them dictated by D.C.:

Right now, you have got Washington, D.C., dictating to the states and dictating to patients exactly what must occur. That’s not how a healthy health system works. A healthy health system works by allowing those individuals closest to the patients themselves to be making those decisions. And from the president’s perspective and our perspective, that means patients and families and doctors making medical decisions, not Washington, D.C.

Secretary Price will be relieved to find out that for the 37 million kids in Medicaid and almost 6 million kids in CHIP with EPSDT benefits, we’ve already achieved his stated goal. The Early and Periodic Screening, Diagnostic, and Testing (EPSDT) benefit is a comprehensive array of preventive and ameliorative care that is broadly recognized as the definitive standard for children. EPSDT requires states to cover all appropriate and medically-necessary services to correct and ameliorate health conditions, but because every child is different, the specific screen or treatment service that must be provided is not defined by federal or state law. Instead, it is up to the treating physician to decide what the child needs to grow and thrive.

So as criticism mounts that the federal government is over-reaching and making health care decisions that would be best left to state and local government, perhaps we can look to EPSDT as a model that does even better – medical decisions are made by patients and families and doctors, not politicians.

Kelly Whitener is an Associate Professor of the Practice at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.