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BearNet News Winter 2011

112th Congress Convenes; Health Care and Fiscal Issues Carry Over as Priorities

On January 5, 2011, the 1st Session of the 112th Congress convened with Republicans in control of the House of Representatives. House Republicans gained 63 seats in the 2010 mid-term elections, giving them a 242-member majority to the Democrats’ 193. Democrats retained their Senate majority, but by a lesser margin of 53 to 47.

Among the issues the 112th Congress will address, many are of particular importance to Children’s National and other pediatric health care providers. They include health care reform, the Children’s Hospitals Graduate Medical Education program and Medicaid, to name just a few. Below is a more detailed look at these important issues.

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Health Care Reform

In a largely symbolic and party-line vote, the House of Representatives voted on January 19 to repeal the recently enacted health reform law – the Patient Protection and Affordable Care Act (PPACA). The House vote was the first step in the Republicans’ strategy to repeal or modify various provisions of the law in the coming months. As expected, the Republican drive to repeal the year-old health care law ended in party-line defeat in the Senate on February 2, by a vote of 47-51.

That same day, the House also approved a resolution that directs the committees with jurisdiction over the health reform law to begin crafting legislation to replace the PPACA. The resolution, which garnered 14 Democratic votes, includes twelve specific health care goals to guide the committees’ work, including lowering heath care premiums, protecting the doctor-patient relationship, and giving states more flexibility in administering their Medicaid programs.

Included in the existing health reform law, however, are many provisions that will improve access to health care for children, including:
  • prohibiting insurers from denying coverage to children with pre-existing conditions and removing annual/lifetime caps on children's coverage;
  • extending the authority and funding of the Children's Health Insurance Program;
  • beginning to address children’s access to care by reducing Medicaid payment disparities through a requirement that Medicaid pay at least Medicare rates for primary care physician services, including physicians in pediatric medicine, for two years;
  • creating opportunities for Medicaid reforms, including new payment models such as pediatric accountable care organizations, medical homes, and other innovations; and
  • creating a $30 million loan forgiveness program for pediatric specialists to help address the national shortage of pediatric providers.

However, additional work remains and Children’s National looks forward to working with policy makers of both parties to address the remaining challenges including:

  • improving Medicaid reimbursement levels that on average are 30 percent less than Medicare for the same services;
  • maintaining and strengthening Medicaid supplemental payments until such time that Medicaid hospital payments cover the cost of care; and
  • addressing economic disincentives that have led to national workforce shortages in pediatric specialties.

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President Proposes to Eliminate Children’s Hospitals Graduate Medical Education Program

President Obama, in his fiscal year 2012 budget, proposes to eliminate funding for the Children's Hospitals Graduate Medical Education (CHGME) program, which provides critical support to 56 freestanding children's hospitals in 30 states – including Children's National Medical Center – to support the training of pediatricians and other medical residents. He has recommended that Congress eliminate funding for CHGME, preferring instead to focus targeted investments to “increase the primary care workforce.”

For 10 years, Children’s National has advocated for federal CHGME funding comparable to the level Medicare pays adult teaching hospitals. CHGME supports physician training at nearly 60 independent children’s teaching hospitals across the country. These hospitals train more than a third of all pediatricians and nearly half of all pediatric subspecialists.

In 2010, Congress appropriated $317.5 million for the CHGME program – the highest funding level to date – but still below the $330 million that would represent parity with Medicare. Several advocacy efforts are underway this year to build upon last year’s historic funding level and educate Members of Congress about the program’s important role in building and sustaining the future pediatric healthcare workforce.

Thanks to CHGME, Children’s National and other children’s hospitals have been able to sustain and improve our teaching programs. The funding has helped expand pediatric training programs and reverse the decline in pediatric residencies that began in the 1990s. In fact, CHGME recipient hospitals have accounted for more than 65 percent of the growth in pediatric specialist training. Children’s National is proud to be among the hospitals that train the next generation of pediatric physicians.

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Medicaid Update

Huge budgetary shortfalls are forcing many states to take steps to gain control over spending, including making significant cuts to their Medicaid programs. Some states – none in the Washington metropolitan region - are even considering dropping out of Medicaid and launching their own programs without federal requirements.

Medicaid is jointly funded by states and the federal government and typically represents the big ticket item in any state’s budget. The recent surge in Medicaid spending can be traced to the economic downturn as more and more Americans lose their jobs and health care coverage, and as more and more employers are forced to drop health care coverage for their employees. As a result, Medicaid spending increased nearly nine percent overall — the highest growth rate in eight years.

Many Americans don’t realize that Medicaid is the engine that delivers most health care for children. More than a quarter of all children and 40 percent of all infants in the United States are covered by Medicaid or the Children’s Health Insurance Program. About 30 percent of children with disabilities rely on Medicaid. Medicaid services for children are far less expensive than those provided to adults and total spending is proportionally less. Medicaid spends more than five times on elderly adults compared to what it spends on children.

Because cutting Medicaid will only exacerbate the problems so many American families with children face, Children’s National will continue its commitment this year to work with our elected officials to explain the facts about Medicaid as a children’s health program.

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Hundreds Join BearNet Advocacy Network at NBC 4 Health & Fitness Expo

On January 15-16, 2011, Children's National Medical Center participated in the NBC 4 Your Health & Fitness Expo with a variety of fun activities and educational booths at the Washington Convention Center. For the sixth consecutive year, the BearNet Team was on hand to register people for our grassroots advocacy network, BearNet.

Thousands of people attended the two-day event, and Children’s National’s grassroots advocacy network, BearNet, enrolled hundreds of new members, bringing our total number of BearNet Advocates to more than 3,000! BearNet members receive four seasonal BearNet News newsletters, each providing information on the local and national policy issues impacting Children’s National and the children and families we serve. Visit Children’s Resource Center for more information.

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Children’s National Advocates for All Children

Since its founding in 1870, advocacy on behalf of children in our community has been at the heart of Children’s National Medical Center’s mission. Today, the “A” in our C.A.R.E. mission – Care, Advocacy, Research and Education – establishes advocacy as a core function that guides the medical center’s strategic priorities and vision.

Advocacy at Children’s National means identifying and studying threats facing children, developing and implementing innovative programs to improve healthcare delivery, advancing positive health outcomes, championing public policies to improve health services and injury prevention efforts, collaborating with other organizations to broaden awareness of child health issues, and ensuring access to equitable health care. Everyday our physicians, nurses, staff and volunteers embrace our advocacy mission and harness the Power of One – the idea that one person can effect change and make a positive difference in the life of a child.

Concussions in Student Athletes
Dr. Gerry Gioia, chief of neuropsychology at Children’s National and an international expert on mild traumatic brain injury, is a leader in championing state laws to protect student athletes and educate coaches and parents about the effects of concussions. With Dr. Gioia’s leadership, Children’s National successfully championed concussion legislation in Virginia during the 2010 General Assembly session. Similar legislation is currently under consideration in Maryland and the District of Columbia.

For several years, Children’s National has supported regional and national efforts to prevent bullying and educate parents, teachers and lawmakers about the consequences of unchecked bullying. Dr. Jorge Srabstein, a child and adolescent psychiatrist and medical director of Children’s National’s Clinic for Health Related Problems Associated with Bullying, and Dr. Joseph Wright, senior vice president of the Child Health Advocacy Institute, are regional and national authorities on bullying. Dr. Wright is the past chair of the American Academy of Pediatrics’ violence-protection committee and helped to write the AAP’s policy statement “Role of the Pediatrician in Youth Violence Prevention.” Drs. Srabstein and Wright have testified on numerous occasions before the Maryland General Assembly in support of anti-bullying legislation and are again this year actively working with lawmakers to advance bullying prevention policies.

Congenital Heart Disease Screening
Congenital Heart Disease (CHD) is the most common birth defect, affecting approximately 8 in every 1000 infants. Early diagnosis of CHD can improve the prognosis of affected newborns, decrease the mortality and morbidity rate, lower risk for brain injury and prevent developmental delay. Currently, no state includes CHD among the conditions for which all newborns are screened. Children’s National and Dr. Gerard Martin, co-director of Children’s National Heart Institute, are trying to change that.

Children’s National partnered with Maryland Delegate Tom Hucker (District 20 -Montgomery County) to introduce legislation to include CHD in Maryland’s standard newborn screening panel. "Diagnosing and treating CHD in its early stages is key. That's why it is so important to have pulse oximetry screening available to all newborns," said Dr. Martin. Pulse oximetry is a non-invasive, painless and inexpensive way to screen for CHD.

Children’s National Medical Center and clinicians at Children’s National’s Heart Institute share the ultimate goal of making screening for congenital heart disease a standard practice for all newborns.

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