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President's Message February 2018

The Future

The future of our country depends on the health and wellbeing of our children. It is imperative that we physicians advocate for strong policies that result in providing straightforward coverage for all our children. Those policies should enable physicians, patients, families and communities to work together to create the healthiest environments for our children.

The following stories are real patients who depend on us to get it right.

John is in the office for his well visit. While talking about school, his mother states that he has missed many school days because of his asthma. John’s mother scheduled this visit early in order to label it as a wellness visit, since their private, employer-sponsored insurance plan fully covers well care. However, she is most concerned about John’s asthma. His recent attack, 2 weeks ago, was severe and he continues to cough during exercise. The family considered taking him to the emergency room, but, due to concerns that the insurance company might later rule that it was not a true emergency which would require the family to pay thousands of dollars, they toughed it out at home. She would like to get John’s asthma under better control. With the new insurance, different medications are needed - the copays for his inhalers are not possible for the family to pay (over $300 per month). They had stopped giving him the maintenance medication 6 months ago when the new insurance plan came into effect. From John’s complete health standpoint, it is extraordinarily difficult to address all the things that need to be done during this visit. We are not able to talk about wellness or preventive care issues due to the complexity of addressing his asthma. Trying to prescribe the medication with the most economical copays is impossible, even with electronic prescribing and coupon cards. Planning for future monitoring of his asthma, including possible referral to a specialist, are visits that will entail copays. When will we be able to address wellness?

The next patient is Mark, who is also missing school because of his asthma. He has CHIP insurance and has a scheduled appointment for this problem. Mark has medication at home. His older sister has recently moved back into the home and assumed care of Mark while both parents work. She is not familiar with the medications or the routine. I am able to directly help Mark, when he needs the help. I explain the medications, answer the family’s questions and develop a plan of action along an agreed upon schedule. We also have time to discuss the impact that John’s sister’s smoking may be having and offer treatment plans for her. I am able to do so much more when parents are empowered to identify their needs and act upon them.

One of my nurses was discussing the help she needs for her child with apraxia, a developmental communication problem. Her family has private insurance and is dismayed that speech therapy is not a covered benefit for this condition. When he was a toddler, his pediatrician recognized that his speech was not progressing along developmental norms. This impacted how he communicated with his family and his daycare experience. Through the First Steps program, which supplements the costs of therapy beyond private insurance, he made tremendous progress. His therapist was able to meet with him individually several times a week. At age 3 years, when First Steps benefits ended, it was necessary to continue therapy. The supplemental payments were now covered by the school system, which required him to leave his daycare to participate in a group therapy session at the local school. Progress continued, although slower. The parents noticed a loss of progress in the hard-earned gains during holiday breaks and summer vacations. One summer, the family paid directly for private speech therapy. It cost them $1800 for that summer, not sustainable from a family economic standpoint. That same summer, his younger sibling was diagnosed with apraxia also. She wishes they had Medicaid so they could receive therapy despite school vacations, following medical recommendations rather than school recommendations. This calls for a child’s medical home directing solutions for children with developmental needs by utilizing family and community resources.

Looking ahead, with the health of our children as the ultimate goal, I fully support the American Academy of Pediatrics Committee on Child Health Financing recommendations regarding adopting certain principles to strengthen efforts to improve pediatric care: