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Health Reform Covers More Children, But Who Will Care for Them?

Cheryl Clark, for HealthLeaders Media, March 31, 2010

A major selling point for the week-old health reform legislation is that it promises to improve care and access for children, accomplished in myriad ways with provisions that take effect in six months or by 2014.

But one nagging problem that isn't resolved is the shortage of pediatric specialty physicians, says Jim Kaufman, vice president for public policy for the National Association of Children's Hospitals, which represents 140 pediatric specialty centers in the U.S.

That's an issue sure to intensify as more children with serious medical issues requiring specialty care are brought in by their parents for treatment, he says.

"It's one of the biggest challenges," Kaufman says. "Children's hospitals all over the country are trying to hire more doctors, but there are problems all over, a huge shortage of pediatricians all over the country. And because of this shortage, children are seeing very long wait times for certain specialties."

A recent association survey discovered that "there are currently 400 positions that children's hospitals can't fill," Kaufman says. He attributes the shortage to the fact that many medical students who would like to choose pediatric specialties rethink their career goals when they realize that the bulk of their reimbursement will come from Medicaid.

For hospitals, it's the same story, Kaufman says. "Medicaid is only covering 67% of the cost of children's hospital costs if you take out disproportionate share [DSH] funding. And if you include DSH, it's 76% but it still isn't covering costs."

Pediatrician Stuart Cohen, former president of the San Diego County Medical Society, says the workforce shortage really isn't all that bad. "There isn't really a shortage of pediatricians. The shortage is the fact that 80% are women–and they don't want to work full-time."

Cohen adds that he doesn't think hoards of very sick children will come in to medical settings seeking care, because most of the children with serious chronic diseases like sickle cell anemia or diabetes are already covered under existing programs for life-threatening illnesses.

However, he says, "We do believe that once they get health insurance through different exchanges or more pools, there will be some sudden demand for surgical procedures, from mild to more sophisticated orthopedic procedures to repairing congenital deformities like cleft lip and palate.

"These are the kids that have been waiting a long time for certain kinds of plastic surgery or cosmetic procedures that are not a medical necessity," Cohen says.

Cohen adds that health reform legislation carries many other benefits for parents and their children. For starters, he says, well-child checkups that now aren't always covered or are covered sporadically by many commercial insurers for children over the age of 6 will now be covered for annual visits until the age of 18.

The new rules will be phased in, "and by the end of the phase in, the well-child checkups won't be charged to the insurance company's deductible."

Other measures in the reform legislation prohibit health insurance companies from denying coverage because of children's pre-existing conditions. That goes into effect on Sept. 23, 2010. And on Monday, Secretary of Health and Human Services Kathleen Sebelius said she will issue regulations to prohibit health plans from using a language loophole to exclude those children, or their pre-existing conditions, from coverage until 2014.

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