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CHIPping Away at Health Care Disparities  

Steven Kairys, M.D at his desk.Once again, health care for children living close to the poverty level is, inexplicably, in jeopardy.

It is not like we are doing so well with child health and safety statistics in the United States that we can afford to let millions of children have their health coverage lapse. An international statistic worth noting is the child health and safety index. It measures all of the relatively wealthy developed countries on three scores: health at age one (a measure of infant mortality and low birth weight), preventive services (immunizations), and safety (death accident and injury). An average score is 100. The best country ranked is Sweden at 120. The worst scored country is the United States at 58.

As a pediatrician, I have never understood the debate, or that there even is a debate, when it comes to ensuring child wellness. There is just so much data and so many studies to show that the best way to have our children become healthy adults is to provide universal preventive services, to screen and identify health risks before they become established (and more costly) and to essentially provide the kind of health care for any child that you would want for your own child.

But "the debate" emerges with an alarming regularity, accompanied by "modest proposals" that will ultimately leave millions of children without access to health care.

On a personal level, I work with families of all incomes and backgrounds. They all love their children, they all seek health care when their child gets sick. They may have poor housing and no transportation; there may be food insecurity and unstable social supports. But at least they can get health care when the fever is too high or the cough too long or the weight loss too scary. There may be arguments for and against a wider social safety net, but I'm at a loss to come up with an argument in favor of not providing health care services for sick children, or preventative services to help ensure that children don’t get deathly ill to begin with.

Twenty years ago Congress in bipartisan fashion agreed that Medicaid coverage left too many of the near poor and working almost poor without health insurance and authorized the Child Health Insurance Program (CHIP) in order to cover these additional millions of children living close to poverty.

The definition of poverty in America is a family of four making less than $24,600 a year. That equates to one or more adults together making about 11 dollars an hour. Medicaid coverage covers up to 120% of poverty, or a little more than 13 dollars an hour. The CHIP program allows each state to determine the level of income; the average is 138% of poverty or about 15 dollars an hour. A few states, such as New Jersey, cover three times the poverty level, and an additional 230,000 children are added to the rolls thereby in the Garden State. Nationally, (even at an average of only 138% of poverty) the added coverage from CHIP all told provides health care for more than 4 million children.

I know too many numbers put people to sleep, but allow me one more: in the United States over 40% of children live at or near poverty. So very few would have health insurance as a benefit of their parent's work place.

Despite all of the national uproar about creeping socialism, about poor people taking advantage of the system, about the power of the marketplace to provide for anyone with the will to succeed, about the damage to our great health system should it be diluted by more governmental mandates and more governmental controls—despite all of the backlash about ObamaCare— the support for children’s health has continued to be bipartisan.

Possibly because the party in power is aware of the universal support of the Democrats for expanded child health care, it is holding it hostage by tying continued support for CHIP to other changes such as stripping ObamaCare of its preventive funding and funding for community health, and cutting back on the percent of federal support for the state CHIP programs.

What I fear the most is that our country is numbed by the daily "breaking news" and the rancor and daily cruelties. There is so much news and so much distortion of the news that you almost have to channel it out in order to get to the next day. And this "channeling out" that seems an almost necessary ancillary to this new culture of rancor and distortion, can make it that much easier to slip in a little cut to the social fabric, a little snip here and another snip there. When polls and expert opinions and world reaction hold no traction, there seems little hope for the little guy in this less than brave new world.

If pediatricians are to be effective again as advocates for children in this current environment, I (we) need to learn new tools. Facts and data will not work, but human stories will.

Jimmy Kimmel got more attention for the plight of children and the dangers of losing CHIP coverage by simply relating the story of his sick child than all the charts, graphs and statistics on the subject combined. He told his story, and noted what the picture could have looked like had he not been insured. His story seems to be making a difference, having started a groundswell of popular support.

But the work is not done. We may not have the platform of Jimmy Kimmel, but we as doctors and medical practitioners do have a voice, and that voice needs to be telling stories of real people going about their lives, living in quiet desperation. We need to portray real people and their acts of unsung everyday heroism and the stories of their children—we cannot sway minds with charts and healthcare comparisons. The charts and data are all there for anyone who wants to look at them. And if anyone really did look at them, we wouldn't even be having this conversation. And so, we have to know as doctors who want to make a difference, presenting facts and comparisons is not enough to change the status quo that now holds children's health hostage.

Change so often begins with changes of attitude, not a change of knowledge. Change demands a readiness, an ability to change, and that involves a different dialog, a dialog that engages and is inclusive.

Doctors, nurses, start telling your stories like some small child's life depends on it— because it probably does.

Steven Kairys, M.D., MPH, is Chairman of Pediatrics at the K. Hovnanian Children's Hospital at Hackensack Meridian Health, Jersey Shore University Medical Center and Founding Chair of the Department of Pediatrics at the Hackensack Meridian School of Medicine at Seton Hall University.

Categories: Health and Medicine

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  • Michael Ricciardelli
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