One hundred and fourteen days after federal health insurance funding for 9 million low-income kids on PeachCare and other programs expired, Congress renewed it. The funding won passage Monday as an addition to the federal spending bill, extended for a full six years.
Georgia pediatricians and family health advocates were elated. But tempering their relief was deep concern that other health funding expected to pass with it did not. Those include federal funds that prop up hospitals and clinics in rural areas and those that serve the poor.
“This is a wonderful event that they got that in the bill,” said Jimmy Lewis, the CEO of Hometown Health, a consulting group for rural Georgia hospitals. “I can’t say enough good things about that and what it’s all about. The other — that’s of grave concern.”
Advocates went through nearly four months of growing uncertainty over whether the health insurance program would even continue. The federal program, known as the Children’s Health Insurance Program, is known in Georgia as PeachCare for Kids, and it covers more than 130,000 here at any given time.
And although the program has been renewed, the delay left harm in its wake.
When asked to explain how such a popular bipartisan program could expire, lawmakers sometimes explained that there was still money left in the bank that would not run out until 2018. But as that money began to run out, some states were forced to send cutoff notices to families. The news spread, creating confusion for some over whether they were still covered.
That happened in Georgia, too. Dr. Robert Geller, the chief of pediatrics for Emory University at Grady Memorial and Hughes Spalding hospitals, has told The Atlanta Journal-Constitution that over the months of uncertainty their patient no-show rate shot up inexplicably by perhaps one-quarter or one-third. There’s no data as to why, but Geller said a likely explanation is some on federal health insurance were uncertain whether they would be covered.
Furthermore, hospitals, clinics and doctors’ offices are businesses, and they had to plan for a cutoff.
“We’re thrilled that CHIP is funded,” said Dr. Ben Spitalnick, a Savannah pediatrician and president of the Georgia chapter of the American Academy of Pediatrics. However, he said, “a business can’t wait until the very last day.
“A business will cycle down,” Spitalnick said. “They won’t hire more providers if that program won’t exist in a few months. If you’re a provider for a program and you’re worried it’s going to disappear, that may alter your new patient acceptance.”
Terri McFadden, the medical director for primary care at Children’s Healthcare at Hughes Spalding, said the importance of PeachCare cannot be overstated because the very fact that a child has coverage encourages parents to get involved in preventive care.
“These are essential health benefits,” McFadden said, adding that she was “very excited” about the program’s renewal. She gave the example of children who have asthma that in the beginning looks just like a cough to parents. Early diagnosis enables care that can prevent flare-ups turning into costly, more dangerous emergencies down the road.
One mother, McFadden recalled, brought her 6-year-old son in with such a cough and learned it was asthma because she had Medicaid and knew the visit would be covered even though it wasn’t an emergency. But after that mother got a $1-an-hour raise, she made too much money to get Medicaid benefits, McFadden said. So would she still get preventive care for her son? Yes, because she now qualified for CHIP.
“Luckily, PeachCare was there for her,” McFadden said.
McFadden pointed to the flu epidemic as a clarion for lawmakers to treat health funding seriously. "Kids are dying across the country. … Those are kids who are not getting preventive care like an immunization or visits that might have prevented an emergency department visit," McFadden said.
“We spend a lot of time selling the concept of preventive health care especially,” McFadden said. “Then we basically negate that by telling our families, ‘Oh, we’ll get to it when we get to it.’ ”
While the delay in CHIP funding is over, it’s still reality for other programs. They include the Disproportionate Share Hospital Program, or DSH, which funds hospitals that care for a disproportionate share of a community’s poor. Cuts to DSH are already in effect, defying assumptions and assurances several times in recent months that the cuts would be delayed as they have in previous years.
Grady Memorial Hospital stands to lose $11 million to $13 million in DSH funding this year alone.
Matt Hicks, the vice president of government relations at Grady, said the hospital has not begun service cuts. “We have talked to members of our delegation and they have assured us that (the delay to DSH cuts and some other federal hospital funding) will be included in the February spending package.”
It’s not easy, though.
“We have been surprised. It’s hard. Because we expected this delay to happen in December. Then we expected it to happen when CHIP reauthorization occurred. And now we’re expecting it will happen in February,” Hicks said. “The best we can do is rely on what were told by members of our delegation.
“The anxiety level is very high about it internally.”
U.S. Sen. Johnny Isakson of Georgia told the AJC on Monday that he was working on DSH. “I’m going to try and get us there,” he said, “but we’re not there yet.”
For anyone who does believe that it’s not urgent to budget a program if there’s leftover money in the bank, think again, said Lewis of Hometown Health.
“That situation creates so much uncertainty from a planning standpoint it’ll drive you out of your mind,” he said
“For a hospital in a rural community, these 60 or so in Georgia, their issue every day is about making payroll,” he said. “If somebody in Washington can figure out how to run a $20 million operation easily on 10 days’ cash, they ought to come down and join the bandwagon.”
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