In his March 24th press release, Rep. Palmer said:
"I believe pulling the bill from the House floor was the right call. The American people have suffered for the last 7 years under Obamacare, and I know we can provide them a better solution that will put healthcare decisions back in their hands, not in the hands of the Federal Government. I look forward to working with my colleagues in Congress and President Trump to do just that. Working together we can still pass a bill that allows Americans to access the doctors they want, decide the coverage they need, and lower their healthcare expenses.
At a February 25th Hoover Town Hall, Rep. Palmer indicated that his solution would include health savings accounts, portability of insurance, and allowing sale of insurance across state lines.
At a February 25th Hoover Town Hall, Rep. Palmer indicated that his solution would include health savings accounts, portability of insurance, and allowing sale of insurance across state lines.
Rep. Palmer needs to provide an analysis of the immense difficulties the current health care system presents before any credibility can be given to his proposed solutions. At a minimum, he should give citations to books or articles which Rep. Palmer believes set forth analysis, information and argumentation that can be consulted to understand the reasons for Rep. Palmer's belief in what he proposes as a solution. Those books and articles may be subject to extensive critiquing, but that is part of evaluating Rep. Palmer's proposed solution.
Maybe Rep. Palmer is only mouthing things said by Secretary Price and by other Trump policy advocates, and maybe Rep. Palmer does not have any particular conviction on his own. If that is the case Rep. Palmer's constituents deserve to know that.
I have been endeavoring to solicit input for health care reform from experts and others in Alabama (see Alabama expertise re health care), but little is forthcoming.
I have been advised that three local pediatricians met with Rep. Palmer and submitted to him the below American Academy of Pediatrics Blueprint for Healthy Children. While it has a narrow focus compared to all of health care in the United States, the blueprint is helpful in evaluating how good a job Rep. Palmer is doing for his 6th district constituents regarding health care reform.
AMERICAN
ACADEMY OF PEDIATRICS BLUEPRINT FOR HEALTHY CHILDREN
·
Affordable
high quality heath care for all health care children
·
Access
to primary and subspecialty pediatric care as well as mental health specialties
CONTINUED
FUNDING FOR MEDICAID IS CRUCIAL FOR ALABAMA CHILDREN
A
large number of children in Alabama, as well as the US as a whole,live in
impoverished circumstances and families cannot afford health insurance for
their children.“Growing up in poverty is one
of the greatest threats to healthy child development. Poverty and financial
stress can impede children’s cognitive development and their ability to learn.
It can contribute to behavioral, social and emotional problems and poor
health.” Annie E Casey Foundation KIDS COUNT 2017
ROLE OF
FEDERALLY FUNDED MEDICAID AND CHIP (ALLKids) INSURANCE FOR ALABMA CHILDREN
In
2017, we had achieved greater than 97%coverage
for Alabama children. 625,000
children rely on Medicaid and ALLKids CHIP for health insurance. By comparison
only 8000 children were covered on Marketplace plans.
The
State of Alabama greatly benefits from the current Medicaid payment structure
to cover children’s health insurance. Current Medicaid funding results in a
tremendous net benefit for Alabama with more than 70% of Medicaid costs for
Alabama paid by the federal government, with the State responsible for the
remainder. Given the serious budget restraints at the state level, the amount
contributed by the state is limited for the foreseeable future.
Both
Medicaid block grants or per capita funding for Medicaid would leave the State
of Alabamahaving to pay a larger share of children’s health care services, or
else to significantly cut services by decreasing the number of insured children
or limiting covered services. With fixed annual federal funding to Alabama,
there would be no flexibility to cover new therapies for diseases, or to
address unanticipated emerging health care problems such as infants severely affected
by Zika virus, or pandemic influenza. Should there be an economic downturn in
Alabama in the future resulting in an increased number of eligible children,
This would further stretch the limited Medicaid funding for children’s
services, resulting in fewer children covered or a marked reduction in
services.
Loss of federal Medicaid
fundingby cuts or by capped funding with block grants or per capita funding
would result in
1.
Great
difficulty for State of Alabama to generate the difference between current
Medicaid funding methods and new funding strategies.
2. Decrease in the coverage of provided services
3. Increase in the number of uninsured
children
Any decrease in
Medicaid funding would not only lead to loss of insurance for children but
ultimately would undermine the pediatric medical and mental health care
infrastructure for Alabama’s children.
One significant
example would be Children’s of Alabama
The
number of inpatient discharges increased substantially between 2013 to
2016: from 13,993 to15,784.Medicaid
is the predominatpayor for inpatient stay at Children’s of Alabama.
Medicaid 65%
Blue Cross 25%
HMO/PPO/Commercial 5%
Other government 3%
Self pay (uninsured) 2%
CHILDREN
LESS THAN 18 YEARS OF AGE LIVING IN POVERTY
(KIDS
COUNT data center)
POVERTY
LEVEL
|
US
2015
|
Alabama
2015
|
Congressional
District
6
|
Extreme poverty <50%
poverty
$12,018 (2 adults,
2 children)
|
6,618,000
9%
|
138,000 13%
|
15,000 (2010)
8%
|
< 100% poverty
$24,036 (2 adults,
2 children)
|
15,000,000
21%
|
291,000
27%
|
20,000
12% (2009)
|
<150% poverty
$36,054 (2 adults,
2 children)
|
23,493,000
32%
|
423,000
39%
|
43,000
24% (2010)
|
Income
Eligibility for Alabama Medicaid
Household
size
|
1
|
2
|
3
|
4
|
5
|
Maximum
annual income
|
$15,800
|
$21,307
|
$26,813
|
$32,319
|
$37,825
|
Alabama
has no minimum wage law: Federal minimum wage is $7.25/hr. Annual salary for
fulltime work (2080 hours) at minimum wage= $15,080, often without benefits
including health insurance, sick leave. Many times employers limit hours so
that employees cannot get fulltime work.
If
a parent misses work to take their children for a doctor visit for a chronic
health problem, they may lose their job: this is a not uncommon if children
have chronic health problems.
MEDICAID
IS THE INSURER FOR 58% of ALABAMA PREGNANCIES
Prenatal
and delivery care are essential for healthy babies!
Alabama
has long had one of the highest infant mortality rates in the nation
·
US:
5.9 deaths /1000 live births (2015)
·
Alabama:
8.3 deaths/1000 live births
“Babies born with a low birthweight have a high probability of
experiencing developmental problems and short- and long-term disabilities and
are at greater risk of dying within the first year of life.” KIDS COUNT data
center
·
US births with low birth
weight: 8% in 2014
·
Alabama: 10.1% in
2014
Births
to women with late or no prenatal care
·
US:
6%, 220,920 in
2014
·
Alabama: 7%, 4204 in
2014
·
Adequate prenatal carefor only76.2%of Alabama pregnancies in 2013
IMPORTANCE
OF INSURANCE COVERAGE FOR MENTAL HEALTH DISORDERS AT PARITY with MEDICAL INSURANCE
In Alabama, 172,000
children or 17% of all children had one or more emotional, behavioral or
developmental conditions in 2011-2012
For
all ages of children and young adults, deaths due to accidents and violence
have a strong behavioral component.
Unintentional
injury
was the leading cause of death for children ages 1-4, 5-9, and 10-14, and 15-24
in 2014, and the fifth leading cause of death for infants less than 1 yr of
age.
Suicide
was
the second leading cause of death for ages 10-14 and 15-24.
Homicide was third leading
cause of death for ages 1-4, fourth for ages 5-9, and fifth for ages 10-14, and
third for ages 15-24.
8,894 Alabama
children experiencedabuse and neglect in 2014 (2017 Annie E Casey Foundation KIDS
COUNT data center). Infants, toddlers and preschoolers are the most vulnerable
for abuse and neglect. It is crucial that these children receive
mental health services for their trauma, as abuse and neglect can have consequences that persist far beyond
childhood: anxiety and depressive disorders, hyperactivity, aggression,
avoidant behavior, increased suicide risk, and poor school performance during
childhood and adolescence (Knutson and DeVet 1995), and in adulthood, increased
depression and anxiety, substance abuse, suicide, personality disorders, and
health issues (Zlotnick et al 2008; Arnow 2004).
INTERSECTION OF
PHYSICAL AND MENTAL HEALTH
Asignificant
number of children with chronic medical issues develop psychological conditions
during treatment for serious conditions, and these can play a huge role in determining
the experience of serious medical diagnoses and quality of life.
Depression
is very frequent in chronic illnesses:
Diabetes: 10-20%
Heart disease: 20-30%
Chronic pain 40-60%
Cancer 10-20%
Neurologic disorders 10-20%
Depression
and anxiety can further worsen perception of pain and function. If both are
present, adherence to treatment and self-care tends to decrease, functional
impairment increases, utilization of medical service increases, and with
increase in complications and even mortality. Children develop abdominal pain,
headache, but also back and limb pain and fatigue with mental health problems
Psychological
and psychiatric illnesses, which are either primary or secondary to a
traditional medical illness, can result in increased health care costs:
1.
Increased
utilization of medical diagnostic testing and
2.
Unnecessary
procedures
3.
Multiple referrals
4.
Inappropriate self-care
(Family Practice 2008, 9:30)
This
increase in costs may be as much as 9 times the average average costs. Indirect costs are due increased absenteeism
at work and decreased work productivity and school absence and poor academic
performance. (Mental Health in Family Medicine 2010; 7:197-207)
The
medical care of children with organ transplants, kidney disease, cancer, and
diabetesare often associated withpsychological challenges. These can impact the adherence to medical
therapies and can lead to poorer medical health outcomes if they are not
addressed. Treating both physical and mental health issues together in a holistic
way results in more efficient use of health care dollars.
The
infrastructure for mental health services in Alabama is already limited. At discharge for Children’s, there is often no
place to send children for continued mental health care once they leave the
hospital. There are large pockets of Alabama where there is no access to mental
health services or only limited or very poor mental health care available.
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