Remarks of Mary Dale Peterson, MD
Speaking on behalf of the Texas Medical Association, Texas Pediatric Society, and Texas Academy of Family Physicians
Support 12 Months' Continuous Coverage in Children's Medicaid
- You've heard why 12 months' coverage is good business. As a physician, I'd like to explain why it is good medicine. Children do not necessarily go to the doctor because they are sick but to stay well. Frequent physician office visits are standard for children in order to assess physical, developmental, and behavioral progress and to diagnose any abnormalities early. Moreover, children especially need preventive health care, such as well-child checks, immunizations, and eye and hearing exams, to stay healthy and productive in school.
- As children mature, health insurance is equally important, especially in the teen years. This is when children may manifest behavioral health disorders that can be managed effectively with early intervention and treatment.
- Uninsured children are 10 times as likely as insured children to skip needed care, even for chronic conditions or injuries. The result is that illnesses or developmental delays that could have been detected during a physician office visit are more likely to go untreated, resulting in even more costly care.
- Indeed, a 2008 California study found that when Medicaid coverage is interrupted, "children suffer harm from less adequate ambulatory care and unnecessary hospitalizations." However, after extending Medicaid eligibility to 12 months, the authors found there were 3,600 fewer hospitalizations of children for preventable conditions with an associated savings of $17 million in hospital costs. A study by the Texas Children's Health Plan found similar results.
- In 2007, Texas reached an agreement in a 15-year-old class-action lawsuit known as Frew vs. Hawkins . The basis of the lawsuit was that children in Medicaid were not receiving needed medical and dental care. Enacting 12 months' continuous coverage would help Texas comply with the Frew vs. Hawkins agreement by preventing unnecessary breaks in coverage and improving timeliness of medical and dental checkups.
- Twelve months' coverage is the norm in private health insurance, and Texas already has extended 12 months' coverage in other publicly financed health care programs, including the Children's Health Insurance Program (CHIP), the women's health program, and CHIP perinatal.
- Lastly, it is important I note that while health insurance is absolutely key to promoting appropriate, timely, and cost-effective health care for children, an insurance card alone will not improve the availability of care. There also must be an eligibility system equipped to accurately and timely enroll children, and there must be a sufficient network of physicians who are able and willing to care for both current and new Medicaid enrollees. Without more competitive Medicaid payment rates, physicians will not be able to afford to participate in the program, making it difficult for families to obtain the care their children need.
- We call on lawmakers not only to implement 12 months' coverage but also to fund a comprehensive package of Medicaid improvements that will promote cost-effective, timely health care for Texas' most vulnerable children.
Last Updated On
March 24, 2011
Originally Published On
March 23, 2010