by Dennis Cooley, MD
It has been a very busy time since the first of the year and I thought I would use this chance to update members on a number of important policy issues facing us.
State Budget. This may be the number one issue facing everyone providing services for children. The state budget is so tight there are no easy cuts left. This affects all pediatricians in a number of ways. First, the Medicaid and CHIP programs have had further cuts proposed. For the rest of this fiscal year payments to physicians for services has been maintained but there is no guarantee they will not be cut for next year. These payments are notoriously low now so further cuts would likely decrease the state’s pediatricians ability to care for these patients. The state newborn screening program could also be in jeopardy. Proposals to have the program funded by a fee schedule as every other state in the country does could be an answer to the problem. But the likelihood of passage of such legislation is problematic in the current climate. Many early childhood programs are likely to see further cuts. What this will mean to our ability to refer patients to these programs is still unknown. In the next week or two we should have some answers as the state legislature finally will hammer out a budget. We will keep you up to date on what that final budget looks like.
Health Care Reform. Although passed into law, the Affordable Care Act is still in a state of limbo. Whether this law will be repealed completely -something I think unlikely- or what changes if any will be made is still uncertain. Much of this hinges on the election of 2012. There are a number of benefits to children and pediatricians included in the ACA that resulted in the AAP supporting this legislation. Among these are: 1) increasing Medicaid payments to Medicare rates for some E/M codes, 2) covering of Bright Futures services with no co-pays, 3) eliminating of preexisting conditions for children, 4)phasing out annual and lifetime caps, allowing young adults to stay on their parents plans until age 26, and 5) supporting pediatric graduate medical education. While the ACA probably won’t be repealed there are a number of ways that opponents of the legislation can change it. This is especially true in regards to appropriations. Parts of the ACA don’t have specific language regarding the funding. If Congress chooses not to fund these areas then the programs will essentially be killed. As a member of the Committee on Federal Government Affairs, I go to Washington D.C. twice a year and discuss these issues with the federal legislators from our state. Most states are going ahead with planning for changes that will be brought about with the ACA. For example, Kansas is currently in the planning process regarding the establishment of a health insurance exchange program. Recently, Chapter Executive Director, Chris Steege and I met with State Insurance Commissioner Sandy Praeger to discuss a number of issues and we were invited to be part of the Advisory Committee on the program.
Immunizations. I don’t know about you, but I am finding that more and more of my time during well child care visits is being spent discussing immunizations. I am seeing more parents ask about alternative schedules and some even refusing vaccines totally. This despite the continuing evidence that vaccines are safe and effective. The irony is that immunization rates in the state which were once near the bottom in the country have improved to the point that now we are among the top. This is due to widespread efforts by numerous groups including the KAAP. My concern is we could lose the gains we have worked so hard to attain. This added amount of immunization counseling time is being felt by providers and we must be paid adequately for providing immunization services. This is why the AAP and the state chapter are fighting to get the CPT codes for administration fees paid at a better rate. The Chapter pediatric council lead by Dr. Jon Jantz and Dr. Kathy Cain has been working hard on this. I urge you all to support them in these efforts which will benefit you and the children of the state.
Infant mortality. The state had the worst black infant mortality rate in the country in 2007. Our overall rate is worse than some third world countries. Because of facts like these, the Kansas Blue Ribbon Panel on Infant Mortality was developed. Three members from the Chapter are on the Panel, including the chair. I encourage you all to go on the web site, http://kansasinfantmortality.org/, and find out about the activities of the Panel. Recently, the state was dealt a setback when we didn’t receive funding from the CDC for a PRAMS program. Finding alternative funding sources for PRAMS has become one of the priorities of the Panel.
These are just some of the important issues facing us. I welcome any questions or thoughts you may have. I also appreciate all of the hard work you do in caring for the children of our state.