Mr. Speaker, I rise today to express my opposition to this horrible bill, and I include in the Record a letter in opposition from the Children's Hospital Association. Children's Hospital Association, Washington, DC, March 15, 2017. Hon.…
Mr. Speaker, I rise today to express my opposition to this horrible bill, and I include in the Record a letter in opposition from the Children's Hospital Association.
Children's Hospital Association,
Washington, DC, March 15, 2017.
Hon. Orrin Hatch,
Chairman, Committee on Finance, U.S. Senate, Washington, DC.
Hon. Ron Wyden,
Ranking Member, Committee on Finance, U.S. Senate,
Washington, DC.
Hon. Greg Walden,
Chairman, Committee on Energy and Commerce, House of
Representatives, Washington, DC.
Hon. Frank Pallone,
Ranking Member, Committee on Energy and Commerce, House of
Representatives, Washington, DC.
Dear Chairmen Hatch and Walden: On behalf of our nation's
children's hospitals and the patients and families they
serve, we believe the American Health Care Act (AHCA) in its
current form is a setback to child health on a national
level. Over 30 million children receive their health care
coverage through Medicaid. The legislation as written
cuts the budget, coverage, and benefits for the care for
children, many of whom have significant health care needs,
including children with disabilities.
Children's hospitals have identified several provisions in
the AHCA that create serious concerns about the bill as
passed by the House Energy and Commerce Committee. Foremost
among these concerns is that the bill would cut the health
care budget for children by converting the Medicaid program
to a per-capita cap system beginning in 2020. This limits
future funding for the states and risks significant
reductions in the Medicaid budgets providing care for over 30
million children. The current Medicaid entitlement financing
structure allows for greater certainty for children in the
Medicaid program and shifting to a capped environment risks
undermining the current health care available to children.
We are alarmed children's health care financing is not
considered and protected in the AHCA, and that children are
exposed to equal funding risk in the Congressional Budget
Office (CBO) estimates that AHCA will reduce overall Medicaid
funding by $880 billion or 25%. Medicaid is the largest payer
for children's health care in the nation and cuts of this
magnitude will have a severe negative impact on children's
health care. There are also discrete program changes
envisioned in the AHCA posing detrimental effects to
children's access to health care. Eligibility policy changes
in the bill risk reducing or delaying access to Medicaid
coverage. We are concerned by CBO's projections that Medicaid
enrollment will substantially decrease under the AHCA and the
absence of information on the impact on children specifically
suggests that additional examination of these issues is
needed.
We support maintaining Medicaid as an entitlement for
children as well as retaining essential elements of the
program. Every child in America should have access to high
quality health care and Medicaid is critical to this aim.
Research shows providing Medicaid coverage for children is a
smart investment for the nation, resulting in better health
outcomes for children into their adult lives and bringing
long-term returns for the country.
Children's hospitals cannot support any bill that does not
safeguard funding, coverage and benefits for children. With
respect to the AHCA, we call on lawmakers to protect kids and
recommend, at a minimum, the following:
We must not cut funding for children's care under a per
capita cap. Children are already funded at the lowest per
beneficiary levels, and ensuring sufficient funding for
children's health care into the future is absolutely
essential. Accomplishing this under the current proposal
requires clear identification of spending for all children,
including those eligible based on disability, and exempting
funds spent on children from a ``claw back'' on any spending
that exceeds per capita cap target expenditures. We believe
spending on all children should be protected from recoupment
in the following year. This is critical to ensuring states do
not have incentives to restrict children's access to
medically necessary care.
Ensure all funding for children, including blind and
disabled children, is clearly identified. Accurate
information on Medicaid spending is vital to evaluating the
program's effectiveness for children and holding states
accountable for the delivery of services. We believe all
children, including blind and disabled children, should be
included in a single children's 1903A enrollee category and
the per capita cap for children should be adjusted
accordingly to reflect the higher expenses of children with
disabilities. Children are a separate and distinct population
from adults. Funding dedicated to children must be
identifiable, allowing for an accurate picture of the federal
and state investment in kids. This is an important part of
ensuring accountability and the availability of sufficient
resources to address children's health care needs. We believe
it is important to consider protections preventing diversion
of resources specifically intended for children. As we work
with state governments to innovate and improve care delivery,
the nation's pediatric providers are in a better position to
help states achieve their goals if all kids are in a common
eligibility category.
Continue requirements that all children receive pediatric-
specific benefits providing medically necessary care
determined by their physicians. The current Medicaid
structure includes important protections for all children and
ensures they have access to medically-necessary care. It is
essential that Congress includes language guaranteeing
continued access to pediatric-specific services provided
under the Early and Periodic Screening Diagnostic and
Treatment (EPSDT) benefit.
Maintain Medicaid coverage levels for children and protect
them from potential loss of coverage or delays in
eligibility. Changes to eligibility, such as ending
hospitals' ability to make presumptive eligibility
determinations, limiting retroactive coverage, or reducing
children's Medicaid mandatory eligibility levels, directly
risk children's coverage and should not be included.
Remove the provision in the bill eliminating hospital
presumptive eligibility authority. Hospital presumptive
eligibility authority allows hospitals to temporarily enroll
children, pregnant women, and other individuals in Medicaid
until their full enrollment determination can be made. This
means earlier access to needed care for Medicaid eligible
children.
Remove the provision in the bill repealing the ability of
states to provide retroactive eligibility up to three months
prior to the month of application, as allowed under current
law. Ensuring retroactive coverage of benefits under Medicaid
is very important for children, especially children with
complex medical conditions. Without this provision, it will
be challenging for families who incur high levels of expense
prior to their Medicaid-eligible child being enrolled in the
program.
Remove the provision in the bill reducing mandatory
eligibility levels for children age 6-18 from 133 percent of
federal poverty level (FPL) to 100 percent of FPL. All other
children are required to be covered by Medicaid up to 133
percent of the FPL.
Thank you again for the opportunity to provide comment on
this legislation. We look forward to working with you in this
Congress to at least maintain the benefits children have
today, and to hopefully strengthen health care for children
into the future.
Very best regards,
Mark Wietecha,
President and CEO,
Children's Hospital Association.