I take care of many special-needs children who depend upon Medicaid. One is a little girl who was premature at birth and continues to have major difficulties sucking and swallowing, such that she needs feedings through a gastrostomy tube that has been surgically inserted into her stomach. She has been in foster care but now is back with her mother. Her mother has major transportation problems and the baby needs to go to an out-of-town medical center to see specialists on a regular basis.
Another of my patients is a 2-year-old boy who was born with a kidney disease that causes him to lose excessive fluid through his kidneys despite two special medications. He has a feeding tube like the first patient so his mother can give him extra fluid when he cannot drink enough fluid to keep from becoming dehydrated. He requires hospitalization whenever he contracts ordinary viruses that cause him to have a fever and/or vomiting and diarrhea. He also needs to travel regularly to a medical center for specialist care.
The American Health Care Act (AHCA) that was passed by the House would bring drastic reductions in federal support for Medicaid, meaning that North Carolina would receive significantly less federal money than it currently receives for Medicaid. The Senate bill makes even more drastic cuts to Medicaid. This would mean our General Assembly may be forced to reduce patient eligibility, reduce patient benefits or reduce provider payments; Medicaid payment is currently about 75 percent of the Medicare rate, making it difficult for many providers to be able to accept Medicaid patients into their practices. The legislature would also be forced to consider appropriating extra money to maintain the current Medicaid system of care. We know that there are multiple demands for funding by the General Assembly. It is not likely that our legislature will adequately fund Medicaid in the face of drastic federal cuts to the program.
My special-needs patients, like the two described above, would likely be unable to receive the care and support they need if the Senate passes the current health care reform bill. I understand that Republicans want to repeal Obamacare, but the cuts proposed now mean that Congress will effectively eliminate the Medicaid entitlement that the United States has fulfilled for the last 52 years.
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Currently our practice is trying to provide comprehensive health services for more than 20,000 children on Medicaid. We turn no one away. If the federal government significantly reduces Medicaid funding, we will likely have to limit the number of Medicaid-eligible children we accept as patients, or cut staffing way back and offer bare-bones health care to patients.
It is very important that people understand the American Health Care Act and the Senate health care bill will be very bad for low-income special-needs children in our community. It is essential that those who care about our state’s ability to provide health services for the neediest members of our population contact our U.S. senators, Richard Burr and Thom Tillis, to express their concerns. This is not about rolling the clock back to the beginning of Obamacare – this is about rolling the clock back to 1965 when Medicaid was established and the United States made a tangible commitment to taking care of low-income and medically complex children.
We must never forget that, unfortunately, every child does not become an adult, but every adult was once a child. If we are to assure that our adult citizens are as healthy and productive as possible, we must provide necessary health services for our low-income, high-risk children.
David T. Tayloe Jr., M.D., of Goldsboro is past president of the N.C. Pediatric Society and American Academy of Pediatrics.