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The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

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Monday
Jan302017

Child Killers

In the first week of the new Congressional session, Senate Republicans took the first step in making good on their promise to gut Obamacare and replace it with... well, who the heck knows.

In typical Washington style, the Republican Senate (no Democrats voted in favor) passed a budget resolution that would defund most of Obamacare’s initiatives, without setting a specific timetable for doing so. In other words, they voted for what they promised without passing an actual law that would make the promise a reality. It was a perfect example of Washington politics: appear to do something without really doing anything.

That doesn’t mean that nothing will happen, though. The House can approve its own bill based on the Senate resolution and then, with a second Senate vote and a reconciliation process, a final bill goes to Trump to sign. What the Senate did last week was to outline their plans for repeal. What they did not do was accomplish anything. Yet.

Since everyone has come to bury Obamacare, I will not praise it. But let’s at least understand that Obamacare is not a thing. There is no Department of Obamacare. There is not a single insurance program developed under the Affordable Care Act (the real name of Obamacare) that was new. The only thing Obamacare did was increase the funding of certain programs, and change some of the regulations for private insurance carriers. No new insurance entities exist. There are so-called Obama insurance plans, but these are just private insurance plans that are adjusted to fit the new regulations and are sold with government subsidies. All of these insurance plans are issued by standard private companies. Nothing new here.

As a doctor, I often encounter patients who wink at me and say, “I bet you hate Obamacare.” Why would I hate Obamacare? Obamacare authorizes more money to pay me, and the payments come from the same companies and organizations who have always paid me. There is nothing for me to dislike. Most of the doctors who dislike Obamacare do so because ideologically they oppose big government programs and don’t want to pay higher taxes. But in the day-to-day practice of medicine, between 2010 and now nothing is different. Same checks, same payers.

I won’t present an ideological argument with about taxes and government here, but I will say that Obamacare changed nothing about the way I practice medicine. The only difference is that there are fewer uninsured. All of the regulations that have changed the way medicine is practiced over the last 10 years have come from a tightening of Medicare law, which is not Obamacare. These changes would have taken effect even if the ADA had never been passed. Nor will they go away if Obamacare is repealed.

Most of the measures the Senate will take to repeal Obamacare are steps I strongly disagree with. Bringing back pre-existing conditions, preventing parents from insuring their own children to the age of 26, and prohibiting insurance companies from imposing lifetime limits -- all of this is manifestly stupid.

But you know what? I don’t care. I’m a doctor, which means I will always be able to get health care. I have nothing to worry about. I can either get my employer to pay for testing I need, or if worst comes to worst, I can ask doctor-friends to help me out. Believe me, I'm good.

It's the people who voted for Donald Trump and have no "in" with doctors who are screwed. They may not realize it yet, but very soon, they will. And I will not feel sorry for them, not anymore. I am tired of feeling sorry for people who choose to sabotage their own lives. Go right ahead, folks. Blow up the ADA. See what happens. I’ll wait. You deserve what you asked for, and you have no idea what you are asking for.

But one aspect of the repeal has me livid -- the cut in funding to the CHIP program. Defunding CHIP was clearly implicated in the Senate vote because, when Democrats proposed an amendment to the resolution to maintain its funding, it was shot down by a nearly unanimous Republican vote. The Republicans mean to kill CHIP. It is one of their political targets.

CHIP stands for Children’s Health Insurance Program. It is a part of Medicaid designed to provide health insurance to poor kids. Its purpose is to extend Medicaid insurance coverage to all children whose parents make too much money to qualify for Medicaid, but not enough to pay for private insurance. Gap insurance for kids, if you will.

And the Republicans, child killers that they are, are trying to shut it down.

As a doctor, I have participated in the CHIP program. I took care of kids first in Louisiana as a CHIP provider and then later when I was in practice in McComb, Mississippi. Like all federal programs, CHIP was not without red tape. But in my experience, it was an excellent program, the kind of thing taxpayers should hope their money is going to.

CHIP is focused on preventative care. To remain in CHIP, parents had to bring their kids in for regular checkups. The kids had to follow immunizations schedules. They had to be screened for hearing and learning disabilities, and doctors had to follow checklists for health monitoring.

As much as, even more than, any other medical program I have participated in, CHIP adhered to American Academy of Pediatrics (AAP) guidelines for child health care. Most insurance programs are fairly weak-kneed about asking doctors to follow state-of-the-art medical standards. But not CHIP. For a doctor to get paid, he or she had to meet AAP standards at each well-child visit. If a doctor refused to follow guidelines, he could be eventually removed from the program.

High standards, preventative care. It is the very thing you want a health program to be.

And for the taxpayer, the view is even better. CHIP provided insurance to kids whose parents made too much money for Medicaid, but not enough to afford private insurance.

Let me state that another way. CHIP is for kids whose parents WORK, but whose parents aren’t making enough to pay for private health insurance.

From where I stood as a medical doctor, CHIP was a pretty good program. It took care of children. It offered a helping hand to parents who were working but not out of poverty yet. And it adhered to medical guidelines for preventative care as established by the American Academy of Pediatrics.

CHIP represents the conservative approach towards government programs. Keep the program narrow and targeted towards groups that would most benefit from the care. Make them modern and in line with the latest thinking in policy (in this case, pediatric medicine). Make them function as a ladder to help people get out of poverty, rather than a crutch.

The last feature, the ladder out of poverty, is crucial here. Poor parents often can’t get jobs with health insurance. And if they manage to get a job, the income from the job makes them ineligible for Medicaid, because in many states any income at all disqualifies families from the program. CHIP allows parents to get jobs and work and not have to worry about their children losing health insurance.

Where is the drawback here?

And yet, Republican leaders have been gunning for CHIP as long as it has been in operation. The standard complaint Republicans voice is that CHIP is federally run, and that individual states should decide for themselves if they want this type of coverage for their citizens. But mostly, I think, they see it as a wedge issue. Working middle class people see poor people get free health care when they have to pay for it, and they get jealous. Attacking CHIP is a way to play to this sense that too many people are getting a free ride.

No one points out the flaw in this argument. The 8 million kids insured by CHIP don’t choose what jobs their parents get. They don’t get to pick their parents, and they can't make money themselves. They are helpless, and therefore without blame for their situation.

The second flaw is thinking that CHIP (and Medicaid, for that matter) are giving “free money” to the poor. Not a dime of CHIP money goes to the poor. You know who gets the money? Me. Nurses. Physical therapists. Pediatricians. Hardworking people who want to take care of kids. Healthcare providers get CHIP money. The patients get nothing but medical care. No money.

So when you oppose a “free ride” for the poor, you are denying money to health care professionals who work hard to help the patients they see. The children are hurt. Their doctors are hurt, when they have to choose between giving free care and abandoning patients who need a doctor.

Today, the 8 million children in CHIP face life without insurance. Some of these kids have serious asthma. Some have cancer. Some have seizures. Some are kids with learning disabilities who need a doctor’s help to remain in school. If these kids lose their health insurance, many of them will unnecessarily suffer, and some of them will die.

And so I salute you, child killers of Washington, DC. Thanks for hurting and killing defenseless children. May the hurt you inflict on others be visited upon you.

On you, Senators, but not on your children. I may be vindictive, but I would never be so cruel as to try to harm a child. To do that, you’d have to be a heartless bastard.

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Reader Comments (3)

You have opened my eyes to the CHIP.
How do you think there is a way out of this situation?
January 31, 2017 | Unregistered CommenterKeane Darren Storm
The way out is to not cancel the program. Congress should know better. Thanks for writing.
February 14, 2017 | Registered CommenterMichael Hebert
Again a very insightful article that finally makes me realize what exactly the ACA does. Thank You from a feeble old gal trying to stay current! Well not feeble, but elderly !
March 4, 2017 | Unregistered CommenterJo Ann Martin Nicholas

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