The Health Care Game of Chance: A Tale of Two Families – Say Ahhh! A Children’s Health Policy Blog

Some of you may have been listening to the Senate HELP Committee hearings this week on its health reform proposal, the Affordable Health Choices Act. There was a lot of talking going on, making it hard at times to see “the forest through the trees.” But Senator Dodd’s opening statement provided some clarity when he reminded us why health reform is so important:

“Imagine two children in Connecticut. One child’s parents are lucky enough to have good jobs with adequate health coverage. He gets to see a doctor. The other folks have fallen on tough times, and layoffs have cost the family not just their income, but their insurance. They can’t take their child to see a doctor. We cannot accept a health care system in which those children are not both treated with the same care. When a family can’t afford to take their child to see a doctor, that is simply wrong – and we have a moral imperative to act.”

In our recent report on what children need from health reform, The Last Piece of the Puzzle, we told a similar tale – showing how two families were forced to roll the dice on health care, with very different results:

  • Sarah McIntyre is an 8-year-old girl living in Yakima, Washington, McIntyre.jpgborn with a hole in her heart and cysts on her lungs, whose life depends on consistent, quality health care. The family could not find affordable health insurance and was struggling to meet their $800 monthly prescription drug bill and other health care costs. Fortunately, Washington recently expanded their Apple Health for Kids program (the State’s Medicaid/CHIP) up to 300 percent of the FPL. Sarah’s family immediately enrolled her in the program and she is now thriving due to the care she receives.

  • Unfortunately, Emily Demko, a 3-year-old girl living in Albany, Ohio, who was born with Down syndrome, is not so fortunate. The family has no health insurance because Emily’s mother had to quit her job to care for her, the father is self-employed, and they can’t getEmily.jpg
    private coverage because of Emily’s pre-existing condition. While Medicaid/CHIP would seem the perfect solution, Emily is not eligible for coverage because the family’s income is above Ohio’s eligibility limit of 200 percent of the FPL. Facing monthly bills in excess of $3,500 the family has been forced to make hard decisions about Emily’s care. She has been reduced to 20 minutes of professional speech therapy a week and has had to go without services such as hearing tests, corrective treatment for an eye condition and physical therapy while the family tries to save enough money to afford them.

Imagine if Medicare worked the same way-a retired couple in Montana receives Medicare, but another retired couple in Idaho does not because Idaho doesn’t provide coverage to seniors making more that $29,000 annually (that’s only 200 percent of the FPL). It just wouldn’t make sense. But that is exactly how it works for many families and the reason why Sarah and Emily, and so many others, have such a large stake in the health reform debate.

In The Last Piece of the Puzzle, we offered solutions for leveling the playing field for children and their families in health reform. Congress could implement a federal minimum standard under which all children up to 300 percent of the FPL receive coverage through Medicaid/CHIP, and families above that income level receive financial assistance to buy coverage. In addition, beyond giving children an insurance card, Congress could ensure that the card translates into the receipt of child-specific benefits.

In the coming months, I will take Senator Dodd’s lead and continue to think about Sara and Emily – to remind myself what health reform is all about: making sure that parents no longer have to make difficult choices on how to provide health care to their children, and that all children receive the care that they need, no matter where they live.

Scroll to Top