You know how you can plan your day to the smallest detail and still something can come up that will completely throw your entire day off. Just last week I dropped my sons off at preschool and camp and headed into work for what looked like a relatively quiet day right before the July 4th holiday. I was looking forward to cleaning off my desk and getting prepared for the following week when Congress would be back in session and health care reform would heat up again. I made it through one hour of work and then the preschool called to tell me my son was sick. These are the kinds of unpredictable days working mothers experience all the time.

The last two weeks of watching health reform activity in Congress and the administration reminds me of the roller coaster of being a working mom. From day to day, one never knows if things will be looking good or not so good on the key issues for children. The schedule for consideration of legislation has slipped a bit in the House and Senate as both chambers grapple with the realities of the price tag to make major changes to the health care system.  The hard decisions that will be made on health reform could have a significant impact on how children fare. Part of the reason for the unpredictability is that the Senate Finance Committee has not released their health reform bill as of yet. Right now, what is in or out of the bill is completely hearsay and changes on a daily basis. How the Senate Finance Committee comes out on two key issues—benefits and access—could have a profound effect on our children’s health care.

Benefits that are designed and tailored to children’s needs seem like a reasonable expectation for children’s health insurance coverage. Would we want benefit packages based on adults’ health care needs applied to children? Although this phrase is overused, it is true—children are not small adults. Children’s health insurance should cover medically necessary care and reflect the unique health care needs of children. Children’s illnesses, diseases and conditions often differ from adults; and prevention, treatment and coverage guidelines for adults can be inappropriate for children.

Whether children are in public programs—such as Medicaid or CHIP—or covered by private insurance, they should have access to a benefit package that provides the services that they need and when they need them. We have seen some encouraging provisions on children’s benefits in draft bills that have been circulated, but we wait to find out what the Senate Finance Committee bill will include and how benefits fare as these bills go through the legislative process. We cannot let the pressure to keep the cost of the legislation down negatively impact these vital benefits for children. 

Just because children have insurance does not mean that they actually have access to health care services. Another essential piece of reform for children is to address the critical shortages in the pediatric workforce. These are the physicians that provide needed health care services for our children. Although some geographic access issues remain for general pediatrics, the most serious shortages are in pediatric specialty care, such as in neurology, endocrinology and gastroenterology.  Adult medicine reports 36 specialists per 100,000 patients, but pediatrics only has 13 specialists per 100,000 children.
We have all waited three to four months to get our children routine appointments with an ear, nose and throat specialist or an allergist. Can you imagine waiting even longer to see a specialist when your child has a serious health issue? Current wait times will only get longer if health reform does not provide support for residents going into pediatric specialty care and ensures the pediatric specialty care physicians participating in Medicaid are paid adequately to cover their cost of providing health care services.

Last week, I had the honor of meeting Secretary of Health and Human Services Secretary Kathleen Sebelius at a meeting where she announced $40 million in funding for outreach and enrollment efforts to get more children enrolled in Medicaid and Children’s Health Insurance Program. Currently, roughly 70 percent of all uninsured children are actually eligible but not enrolled in Medicaid and CHIP. These new funds will allow many of these children to be enrolled. Unfortunately, even with this funding many states because of budget pressures won’t be able to pay to provide health coverage for these children and that is why health reform that addresses children’s needs is critical. This is why when he signed the Children’s Health Insurance Program Reauthorization Act the President said, “I refuse to accept that millions of our kids fail to reach their full potential because we fail to meet their basic needs. In a decent society, there are certain obligations that are not subject to tradeoffs or negotiation—health care for our children is one of those obligations.”

Now it’s time to fulfill this promise to the nation’s children and ensure that all children have real access to the health services they need when they need them. You can help by sharing your story with your elected representatives at www.speaknowforkids.org.