Archives for June 2017

Medicaid Must Be Saved

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP

(As healthcare reform continues at a fast pace in the US Senate, Chapters have been working to highlight the impact proposals within the Better Care Reconciliation Act will have on children.  Given Medicaid’s vital role in providing health insurance to children, protecting its budget from impacting children, particularly those with disabilities, is a vital national American Academy of Pediatrics’ priority.  Here, two active AAP members from neighboring chapters, Drs. Shetal Shah and Heather Brumberg, discuss the importance of a strong Medicaid program on children in New York and children’s hospitals.  More importantly, they highlight how Medicaid reductions will result in decreased access to subspecialists for ALL children, irrespective of insurance status.  This blog post was originally published as an Opinion-Editorial piece in The Journal News, a prominent newspaper in Westchester.  It is available at:



As the landscape of healthcare reform shifts rapidly, it’s clear the federal Medicaid Program – the nation’s largest insurer of children – is in jeopardy.  Over the next two weeks, the United State Senate will debate a version of the American Health Care Act, also known as the “ObamaCare Repeal,” which drastically endangers the care of children.  The House of Representatives version of this bill defunded Medicaid by $834 Billion over 10 years and President Trump’s recently released budget was even more drastic – calling for $1.3 Trillion dollars in cuts over the next decade.

As pediatricians and neonatologists, we know firsthand such measures would be devastating to the critically-ill babies we care for, over 70% of which receive Medicaid coverage.  These babies are among the most gravely-ill in New York State, often weighing less than 3 soda cans.  There are roughly 3,300 of these babies born each year in our state.  They are at risk for heart, lung, intestinal and eye disease as well as cognitive delays.  The care our team provides saves their lives and gives them the best chance at growing up to be healthy adults.  But these treatments are made possible by health insurance programs like Medicaid.

Nationally, Medicaid is fundamentally integrated into child health, covering 40% of all children, including 1.78 Million kids in New York.  In our area, more than a third of children rely on Medicaid for healthcare.  That number is expected to grow.  Data from the University of Pennsylvania suggests the combination of higher annual contributions and increased deductibles for family plans will result in even more children from working class families ($49,200 for a family of four) shifting to public insurance.

Children depend on Medicaid.  Pediatricians depend on Medicaid to ensure that every child, no matter what tax-bracket they were born into, has access to the care they need.   Without this strong child health insurance program, our babies born more than a trimester early, or born to mothers addicted to opioids won’t have access to the care they need.  Other children won’t have access the life-saving vaccinations, autism screening and other preventive healthcare.  This leaves parents dependent on the emergency room for their children’s care, increasing costs and causing unnecessary suffering for children who could have had mild conditions treated by a pediatrician before they got worse.

Even if your children’ aren’t in the program, your family will be affected.  Since Medicaid covers so many kids, local children’s hospitals, including ours, disproportionately rely on Medicaid payments.  Without those funds, hospitals will reduce personnel, which impacts all hospitalized children, regardless of insurance status.  Medicaid funds also support school nurses, and allow hospitals to afford more physicians who provide mental health care and treatment for behavioral problems – increasing the ability of all kids to see specialists.

Economically, Medicaid also covers a great share of children with special health care needs, including children with cancer, sickle-cell disease and cystic fibrosis.  It’s estimated Medicaid saves $2,800 per child annually.  Without this support, these children will receive uncompensated care by a hospital; increasing the charges for private insurers who ultimately relay those costs to their beneficiaries via increased premiums.

Reductions in Medicaid funding, often labelled as reducing “entitlements” are shortsighted and ignore the demonstrated societal cost savings of insuring children’s health.  These proposals also ignore the long-term effects of having a healthy childhood.  Healthy children become more successful adults.  Throughout childhood, kids who receive Medicaid are more likely to complete college, pay more taxes and grow to healthier adults.  Sadly, this 18 year period doesn’t coordinate well with election timelines, putting Medicaid under threat.

Children are 0% of the vote and 100% of our future.  As parents, we know there is nothing we wouldn’t do for our children.  Medicaid has been there for our poorest children, allowing them to stay healthy.  It’s time for pediatricians and parents to be there for Medicaid.

(Dr. Shetal Shah is the Legislative Secretary and Secretary for the American Academy of Pediatrics, District 2, Chapter II.  Dr. Heather Brumberg is Vice-President of the American Academy of Pediatrics, District 2, Chapter III.)