How will the Supreme Court decision to uphold President Obama’s health reform law impact children?

James Mandell, MD

Regardless of your political views, yesterday’s Supreme Court decision to uphold President Obama’s health reform law, which was originally passed in March 2010, was historic and will touch the lives of nearly every American in some way or another.

As the CEO of one of the nation’s largest hospitals for children and chairman of the board for the Children’s Hospital Association, I’m focused on how this law impacts children and their families. As I said in 2010, I believe there are several positive things related to pediatric health in this law, namely:

  • Insurance companies can no longer deny coverage for any child with a pre-existing condition.
  • There are no lifetime limits or exclusions on insurance coverage.
  • Young adults can now stay on their parents’ insurance plans until they’re 26.

These essential elements survived the Supreme Court’s decision when it voted to uphold the legality of the individual mandate (the requirement in the law that everyone buy insurance or pay a penalty). What’s less clear at the moment is the impact of the Court’s decision on the Medicaid Program. Approximately 16 million people (mostly uninsured single adults) were expected to gain coverage through a significant Medicaid expansion paid for by the federal government. In the Medicaid part of the opinion, the Court decided that states had to have a real choice about whether they wanted to expand their existing programs consistent with the health reform law; the majority believes that states should not be forced to jeopardize their existing programs and funding if they choose not to expand coverage this dramatically. This could clearly lead to some states opting out of the Medicaid expansion in the short term, despite the guarantee of federal funding for almost all of the cost.

Medicaid is essential to child health in this country. It is the single largest payor for pediatric care, and has improved access and health outcomes for millions of children nationally. Notwithstanding these successes, it is a program with significant challenges. It tends to be underfunded and over-politicized. It is too often stigmatized as a “welfare” program or a “budget buster.” It is sometimes challenged by a lack of resources to innovate in its financing and care delivery. As a regional and national center for complex care, Medicaid’s state-based management structure can cause real problems for Boston Children’s clinicians attempting to treat and coordinate care for the most complex patients. The court’s decision fortunately preserves this essential program for children; we will have to wait to see whether it has simultaneously destabilized the Medicaid program in significant ways.

Of course, the Supreme Court’s decision will not solve all of the country’s health care challenges, but it hopefully provides us with some clarity and an ability to focus actively on the issues at hand. Regardless of the Supreme Court’s ruling, there is no question that institutions like Boston Children’s Hospital will continue to face incredible pressure to deliver higher quality care at a lower cost. This is, no doubt, a complex undertaking.  We need to embrace this challenge and recognize that our successes will pay long-term dividends for children. We must use the incredible resources of this institution—incredible clinical depth and breadth, ability to innovate, capacity to demonstrate results, and shared sense of purpose—to provide both local and national leadership. We will benefit our patients, we will benefit state and federal governments, and we will ultimately preserve the mission of the organization if we succeed. I truly believe this is the best response, not only to the Court’s ruling, but also to the issues confronting all of us who care about children.

Previous blogs on health reform, cost, etc. (March 25, 2010) (July 18, 2011) (March 16, 2010)

Judy Palfrey’s post on Health Reform: (March22, 2010)

Sandra Fenwick’s post on BCBS deal: (Jan. 24, 2012)

Sandra Fenwick’s post on our cost-cutting efforts: (March 7, 2011)

Sandra Fenwick on reducing health care costs: (April 16, 2010)

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