Don’t harm children and call it 'reform'

Reforming health care requires tough choices. But choosing to take health coverage away from tens of millions of children, people with disabilities, and seniors in nursing homes should not be one of them. The Trump administration’s budget, in concert with Republican legislation to repeal Obamacare, would cut Medicaid – our nation’s principal program for insuring children – by a staggering $1.4 trillion over the next decade. Sadly, what the president calls an “America First budget” would put children and other vulnerable Americans last.

Medicaid is widely misunderstood to be a program only for the poor. Here are the facts: Medicaid serves 28 million children (including almost 93,000 in New Hampshire, one third of our under-18 population), 28 million adults (mostly in low-income working families), more than 10 million people with disabilities, and nearly 6 million seniors. Seniors in nursing homes and people with disabilities account for nearly two-thirds of all Medicaid expenditures. Republican leaders propose to cut Medicaid funding nearly in half by 2027, and that is simply not possible unless tens of millions of people lose coverage.

In New Hampshire, the expansion of Medicaid under the Affordable Care Act has been a critical tool in our fight against the opioid epidemic, securing access to life-saving treatment for nearly 11,000 Granite Staters with substance use disorders. By terminating Medicaid expansion, the Republican bill to repeal Obamacare puts these gains in jeopardy. Other vulnerable populations would also be hurt.

Pediatricians at Children’s Hospital at Dartmouth-Hitchcock have witnessed countless success stories made possible by the Medicaid expansion. For example, today Kate is a healthy eight-month-old baby and is developing beautifully. But a little more than one year ago, her mother Kim was a heroin user. Thanks to the Medicaid expansion, Kim saw a primary care provider and midwife who helped get her into treatment. Today, Kim is in stable recovery, back at work, taking care of baby Kate. Without Medicaid, Kim might have ended up in jail or worse, and her child might have been born as a drug-dependent baby facing the agony of withdrawal.

Parents of children with disabilities – including children born with birth defects or chronic illnesses – are especially fearful of the proposed cuts to Medicaid. For them, Medicaid is a lifeline that helps pay for medical supplies, surgery, and therapy. In addition, New Hampshire school officials fear losing millions of dollars in Medicaid funds that help students with disabilities such as cerebral palsy to attend and participate in school.

Draconian cuts to Medicaid are a classic case of penny-wise-pound-foolish budgeting. Medicaid provides comprehensive prenatal care, allowing millions of women to have healthy pregnancies and helping millions of babies to get a healthy start. Studies demonstrate that children in Medicaid are more likely than their uninsured peers to get checkups, miss fewer school days, graduate and enter the workforce. Senate Republican leaders are now working behind closed doors and without public hearings on Obamacare repeal legislation that they hope to pass before July 4. Like the bill passed by the House, which President Trump has called “mean,” the Senate bill is a vehicle for making brutal cuts to Medicaid while cutting taxes by hundreds of billions of dollars, with the lion’s share going to those at the top.

There is a better way forward for our country – one that does not jeopardize the health of children and other vulnerable populations. The great majority of Americans want members of Congress to come together in a bipartisan effort to strengthen the successful elements of Obamacare – including the Medicaid expansion and the law’s guarantee of coverage for people with preexisting conditions – and to fix what’s not working.

Physicians live by a time-honored principle: do no harm. Members of Congress should do the same – especially when it comes to protecting the well-being of our nation’s children.

Jeanne Shaheen is the senior U.S. Senator from New Hampshire; Dr. Steven Chapman is Director of the Boyle Community Pediatrics Program at Children’s Hospital at Dartmouth-Hitchcock and president of the New Hampshire Pediatric Society.