Category Archives: Advocacy and Health Policy

More kids covered

This is a post by Children’s Health Policy and Advocacy team. They’re nonpartisan and proudly serve as child health experts and as a resource for our elected officials. Follow Children’s Policy and Advocacy staff on Twitter.

Approximately 16,000 children will now be insured and have access to healthcare thanks to a finally implemented 2009 law. That is great news for kids and their families.

The healthcare expansion will cover working families who make between 150 percent and 200 percent of the federal poverty guideline(FPG) and will improve their access to care and preventative services. The new law eliminates the current four-month waiting period previously required and will allow every child under 18 to be eligible for MinnesotaCare, Minnesota’s subsidized insurance program for working families.

Those children under 200 percent of the FPG will be eligible for MinnesotaCare without premiums. Prior to the changes, a family of four earning less than $46,000 would have to pay premiums of up to $70 per child in order to participate in MinnesotaCare.

The new healthcare expansion is estimated to cost $11 million a year when fully implemented with the federal government covering half.

While this is certainly great news for the newly covered 16,000 children, officials estimate there are anywhere from 71,000 to 84,000 children who still lack health coverage. Minnesota is also the only state in the country that saw an increase in the number of children covered by health insurance last year, dropping in rankings to 27th in the country. According to the Annie Casey Foundation 2012 Kids Count Data Book, Minnesota also dropped from second to fifth in the nation in the overall well-being indicators for children.

While we applaud the new law and successes in getting more kids covered, it’s clear there is still a lot of work to do. Every child deserves a chance to be healthy.

To read the entire Kids Count Report, click here.

The Johnston family goes to Washington

This is a guest post by John Johnston, dad to patient Mike Johnston, who was diagnosed with a tumor in 2011. His family will be in Washington, D.C., next week for Family Advocacy Day. In its eighth year, the Children’s Hospital Association 2012 Family Advocacy Day brings patients from children’s hospitals and their families to tell their stories to lawmakers on Captiol Hill.

The Johnstons

On April 18, 2011, we took our 13-year-old son Mike to Children’s in St Paul. That day, our family began receiving treatment from Children’s. It turned out that Mike had a cancerous Germinoma tumor that was blocking the flow of cerebral spinal fluid. The fluid was building up in his skull, putting pressure on his brain and causing him to have tremors and headaches. As we began Mike’s cancer journey, it became obvious to our family that Children’s not only treated the patient, but they treated the entire family. Every staff member who came into our room introduced themselves to all of us, including 7-year-old Emma. We felt secure with the staff since they all made time for us and made us feel like we were their only patients at the moment.

Throughout Mike’s treatment, several important events were planned. The first was the American Cancer Society’s Relay for Life in White Bear Lake, Minn. Mike was one of the featured speakers. The oncology team scheduled chemotherapy and other appointments to make this special event possible for Mike and our family. The second major event for Mike that summer was his junior high school trip to Washington, D.C. This was an opportunity he couldn’t pass up since the teacher in charge was Mike’s favorite teacher and helped Mike get passionate about history. Mike enjoyed the monuments and museums in our nation’s capital and was able to take it all in despite his low blood counts.

Throughout our family’s journey with Children’s, we all felt blessed to have this institution charged with our son’s care. We felt so proud to have Children’s in our life that our family made a commitment to give back. Mike is now a member of the Youth Advisory Council, and my wife and I participate in the Families as Partners program. This all led to the upcoming opportunity for our family to travel to Washington, D.C., to advocate on behalf of Children’s. We’re very excited for this chance to give back. We even accepted this opportunity knowing that we would travel on Emma’s ninth birthday. We can hardly wait to see the sites as a family and meet many wonderful people who’ve also been touched by Children’s.

See you in Washington!

INFOGRAPHIC: The Weight of Childhood Obesity

At Children’s Hospitals and Clinics of Minnesota, we’re seeing a growing number of overweight and obese children. To address this new reality, we’re closely examining how we treat kids with weight problems. In a report we released today, we explore how Minnesota kids are faring in the battle against obesity. The earlier we tackle this problem, the better. To learn more, click here to see our report.

 

What the U.S. Supreme Court’s ruling on the Patient Protection and Affordable Care Act means for kids

This is a post by Children’s Health Policy and Advocacy team. They’re nonpartisan and proudly serve as child health experts and as a resource for our elected officials. Follow Children’s Policy and Advocacy staff on Twitter.

Today, the U.S. Supreme Court upheld most of the Patient Protection and Affordable Care Act (ACA).  In a 5-4 decision, the Court not only upheld the individual insurance mandate, but upheld a host of other provisions important to Children’s.

With ACA intact, private insurance reforms for children will remain, including: children with preexisting conditions will not be denied insurance coverage; children who undergo expensive procedures will not have to worry about annual and lifetime insurance caps; and young adults can stay on their parents’ insurance up to the age of 26.  The law also authorizes, though does not fund, the formation of demonstration Pediatric Accountable Care Organizations, which are designed to improve and streamline care.

It is still unclear at this time how the Court’s ruling will affect the temporary increases in Medicaid reimbursement rates for pediatricians and pediatric specialists, as well as maintenance of the current Medicaid and Children’s Health Insurance Program (CHIP) coverage for children through Sept. 30, 2019.

The most substantive change arising from this decision is around Medicaid.  Expansion of Medicaid has been limited, and is now largely left up to states to implement. States may maintain pre-expansion eligibility levels and receive current levels of funding, or they may comply with the federal expansion requirements and receive the corresponding federal funding. This decision will make it all the more important to make sure we protect Medicaid funding at a state level.

More than just a playground: Nathan’s story

The following is a guest post from Kristen Spielman, the mother of a patient at the Woodwinds Clinic in Woodbury, MN.

Our son, Nathan, has had quite the journey since he was born 3 years ago. Many of you have walked a similar road. Just like us, you’ve cried, prayed, and rejoiced over your little one. I’d like to share our story with you and ask you to join us in helping Nathan, and other children with similar challenges, make even bigger strides than they are currently making in Physical, Occupational, and Speech Therapies.

The day Nathan was born 3 years ago, the doctors told us that there was something different about him. His high palate, droopy eyelids, adducted thumbs, and perhaps most significant, his extremely low muscle tone, were all indicators that Nathan had a genetic syndrome. He has logged many hours with the special education department of our school district and has endured numerous blood draws and brace- and helmet-fitting appointments.

Most important to his development, Nathan has worked consistently in physical therapy, occupational therapy, and speech therapy three times each week at Children’s Woodwinds Clinic in Woodbury, MN.

Last August, just before his third birthday, Nathan finally received a diagnosis. He has Multiminicore Disease, a rare genetic muscle condition in which his muscle cells will always only perform at a small percentage of normal function. As you can imagine, this affects EVERYTHING he does, from talking and chewing to gross motor skills. Nathan’s life will always be more difficult because of his disease, but his ability to communicate and perform daily tasks, quality of life, risk for falls, and movement is greatly improved through the therapies he learns and does at Children’s Woodwinds Clinic.

A unique opportunity has arisen at the Woodbury Clinic. An adjoining property right out the front door recently became available to Children’s. It was formerly the outdoor play area for a daycare. The current vision is for this area to be developed into a therapy playground.

For obvious reasons, one might think that such a playground would only be useful for Physical Therapy.  However, as the mom of a recipient of physical, occupational, and speech therapy, I can say with confidence, that it would benefit children receiving therapy in any of the 3 disciplines.

Megan Shepherd, a therapist at the Woodwinds Clinic, agrees. “A clinic playground would allow therapists to teach kids how to safely play and fully experience playgrounds at their neighborhood parks.”

The “work of play” is a child’s job. In my opinion, many of those “work hours” should be logged on a playground. Upon a child’s entrance to school, the playground will be an important learning space, second only to the classroom. Social skills, friendships, cooperation, and body awareness are only a few of the lessons that will be obtained there. How much better prepared will our children be for that environment if they know how to use a playground safely, effectively, and without fear?

Would you please join me in making it possible for this “Children’s” playground to be built?  Thank you for considering this opportunity. Your gift will bless Nathan, and in turn our family, and many other children and their families in countless ways for many years to come.

You can find more information about the project and make this playground a reality with a gift at GiveMN.

Changes to Newborn Screening Program will Hurt Kids and Community Health

A recent rulilng by the Minnesota State Supreme Court requires the Minnesota Department of Health to destroy all newborn screening blood samples after 71 days. This is a troubling setback for a program that has succeeded at improving public health and saving the lives of children.

The blood samples will no longer be stored for possible analysis if a child or a sibling develops a health issue beyond those 71 days. They will also not be made available for use in important tests about health problems like immune deficiency disorders or public health dangers.

As a geneticist at Children’s Hospitals and Clinics of Minnesota, I have seen firsthand how the newborn screening program saves lives. Our ability to detect rare and life threatening genetic conditions early on allows us to treat children proactively, in many cases saving their lives and allowing them to grow into healthy kids and adults. Storage of these samples is critical so we can go back when needed to these spots and test issues that emerge later in life or conditions involving relatives.

Here are just a few examples of why the availability of previously collected samples is important:

  • Newborn screening spots may detect patients with rare inborn errors of metabolism. The registry allows physicians to use the blood spots to confirm diagnosis. This confirmation prevents delay of necessary care or repeated unnecessary testing.
  • SIDS is the unexpected, sudden death of a child under the age of one. Typically a medical evaluation does not show an explainable cause of death. The newborn dried blood spot is the only available sample left to grieving parents and physicians striving to understand the cause of SIDS. If a second child in the family is diagnosed with a rare disorder, the family may request the blood spot to understand if the baby who passed away had the same disorder. Similarly, some infants with near SIDS present to an emergency room quite ill. If they are transfused with blood, the only way to get a repeat blood specimen that is untainted with anyone else’s blood products emergently is to obtain the newborn screening card.
  • For a child who has failed the hearing test, it is important to know if they were born with an infection called cytomegalovirus (CMV). In most people, children and adults, CMV causes a cold. It is only if the mother had CMV during pregnancy that the infection may cause congenital hearing loss. When a child has recognized hearing loss within the first year of life, the only way to know definitively if there was a congenital CMV infection would be to check the newborn screening card. Otherwise, it’s impossible to know when the infection occurred, in utero vs. later after the baby was born.

I hope that Minnesota can act quickly to save this program, and retain its leadership in the area of health screening and public health research. At the very least, before we continue destroying potentially valuable blood spots, let’s have a clear discussion about the impact of this action.

Once a blood spot is destroyed, we can never recover the information contained in the sample. We owe it to our kids, their parents and our communities to pause, evaluate, and communicate a clear direction forward that will allow health professionals access to blood spots. I trust that an informed discussion will point us to the right decisions and will allow us to maintain and improve upon this extremely valuable program.

 

Nancy Mendelsohn, MD
Medical Director – Genetics Clinic
Children’s Hospitals and Clinics of Minnesota

Family represents Children’s in D.C., meets with lawmakers

Last week, Heather and Tim Gillen and their two children, Ally (12) and Nate (10), traveled to Washington, D.C., to meet with elected officials and to advocate on behalf of issues that are critical to children’s health.

The Gillens traveled as representatives of Children’s Hospitals and Clinics of Minnesota. Ally has been undergoing treatment at Children’s for Dermatomyositis, a rare and life-threatening auto-immune disease.

While in D.C., the Gillens met with members of Minnesota’s Congressional Delegation and asked them to protect two programs that are critical for children:

  1. Medicaid – The single largest payer of children’s health care in the country, covering more than one in three children
  2. Children’s Hospitals Graduate Medical Education Program (CHGME) – A program that is critical for providing support and training for pediatric specialists

The Gillens spent three days in the nation’s capital, and they sent back the following account of their journey:

July 23rd, 2011

We are here! The Gillens have arrived in Washington, D.C.! We are so excited to be here to represent Children’s Hospitals and Clinics of MN at NACHRI Family Advocacy Days.

July 24th, 2011

The morning started off with a visit to the Smithsonian Museum of Natural History. The building itself is breathtaking and the exhibits were amazing. Ally especially enjoyed the Egyptian mummy exhibit as she studied Egyptian history last year in school. Nate loved the mammals exhibit.

In the afternoon we attended the IMAX show, “Born to be Wild.” The show was about two extraordinary women who have devoted their lives to helping animals. One saved baby orangutans in Borneo and the other saved baby elephants in Kenya, all with the goal of restoring their health and returning them to the wild. As I watched the show I with struck with the thought that this is the reason we are here in DC. We are advocating for children so someday they too can grow up to be healthy and successful.

I have decided D.C. is a good place to be if you have Dermatomyositis like Ally does. She can stay out of the sun and in these cool marble buildings without worry.

Tomorrow we begin our NACH journey. We are excited to share our story and help make a difference for all kids.

July 25th, 2011

This morning began with our radio interview. Ally and I spoke with WYRQ-FM in Little Falls MN. We shared that we were in D.C. to represent Children’s and to put a face to critical issues, especially surrounding Medicaid and the Children’s Hospitals Graduate Medical Education Program.

We had a wonderful lunch with the other families. It was the first time we were all together and meeting other families from around the U.S. was amazing. Ally got to share her own personal NACHRI trading card with the other children in attendance. They had such fun trading cards and getting to know each other better.

In the afternoon we had a family briefing session about the legislative meetings the next day. After the meeting we had a special surprise guest – Miranda Cosgrove from the Nickelodeon Show “iCarly” came to sign autographs and have pictures taken with all the kids – so fun and exciting! The kids LOVED meeting a celebrity.

Afterwards we headed out for a tour of the Capital with special tickets from Rep. Paulson’s office. It was great to hear about all the behind-the-scenes facts about the Capitol building. It is a huge place and I do not know how you would not get lost there. I suppose it is kind of like the hospital and sooner or later you just figure it out.

Our evening concluded with a wonderful party sponsored by NACHRI for all the families. NACHRI sure knows how to make each and every one of these kids feel welcomed and special (siblings included). For Tim and I, it was nice to be able to talk with other families who have also experienced health care crises with their children. You often feel so alone, no one really understands, but in that room everyone in their own way completely understood.

Tomorrow is our big day! We hope that we can make a difference with our story the way families have for years before us. I keep thinking about the fact that 3 years ago, as we were experiencing our own life turning upside down, another family was in DC sharing their story and making a difference for us.

July 26th, 2011

Our morning started out bright and early with a great send-off breakfast. Everyone looked so great all dressed up and ready for their legislative visits.

We had a very full day of meetings including:

•  Senator Klobuchar – This was our first meeting and the first time telling our story on Capitol Hill. Ally was a little shy and mom was a little teary eyed (I know, I am sure those of you who know me can’t believe I cried. I am just hoping the day will get easier each time we re-live the story). Good thing Dad was there to take over and help fill in the pieces. Senator Klobuchar invited us into her office and even had a Target Field book on her coffee table that she talked to the boys about (Nate keyed in on that right away).

Representative Paulsen – We meet in Rep. Paulsen’s office and Ally again shared her story. The part of the story that Ally loves telling the most is about the therapy dogs and how they made such a difference for her. Ally brought along a scrapbook of her time in the hospital and the therapy dogs and Rep. Paulsen was especially interested to see what she had created. He asked questions and looked at all of her pictures.

Representative McCollum – We meet with her Legislative Assistant and were briefly able to see Rep. McCollum before she left for another meeting. She was gracious and offered that if we needed anything while we were in DC to just let them know.

Representative Walz – Who found a last minute break in his schedule to meet with us in person.

Senator Franken – This was our last meeting of the day. For those of you who do not know, Senator Franken has his own office dog whose name is Blaine. He and Ally had an immediate connection. They both believe in the healing powers of our furry friends.

We also met with staff representing:

Rep. Bachmann

Rep. Peterson (whose office is full of animals including a huge elk on his office wall! He also had a framed picture on his wall that a child at Children’s had painted)

Rep. Kline

Rep. Ellison

Rep. Cravaack

As our day came to a close, we were hopeful for the difference that our story and the stories of 39 other families doing this same thing on this same day in Washington DC might make as these lawmakers move forward with the tough choices regarding budget cuts.

We continue to hold tight to the fact that this happened to Ally for a reason and all of this is part of that plan.

Good night from D.C!

The Gillens

How we advocate for children

Scott Leitz After spending the better part of this past weekend watching the legislative sausage being made (and spending a few too many late nights at capitol), I have a few observations to share.

First, as much as its convenient to grouse about politicians, the fact is they have very hard jobs that they do in a very honorable way.  I have the luxury of focusing on health care issues, but the average legislator, in addition to knowing about health care also needs to know agriculture policy, tax policy, economic development issues…and the list goes on.

Second, the challenges facing our state are enormous.  Not only do we have a budget deficit this year, we’ll have a huge one waiting for the new incoming governor next year.  And the range of perspectives among lawmakers (and the public) on how to best proceed moving forward are really quite vast.

On the one hand, Minnesotans are justly proud of the investments we’ve made over the years in education, health care, the environment and other areas.  Many legislators and policymakers feel passionately that we’ve backslid in some of those investments the past few years, and would like to, at a minimum, stop what they consider to be additional slippage.  On the other hand, other policymakers feel just as passionately that our investments have to match up with our means, and that the state spending should be restrained.  In a time of deficit, these two perspectives can be very hard to reconcile, and the process of trying to come to agreement can be messy.  And without good information, sometimes decisions can be made that have unintended impacts.

This is where advocacy can play an important role.  We’ve been working this session to help to educate lawmakers about the importance of Medical Assistance (MA) to pediatric hospitals.  Let’s face it: legislators face tough choices this year in Minnesota—without new revenue, they have to do the best they can within existing resources to make the best policy possible.   That can mean reducing MA and other payments to health care providers like Children’s.

Unfortunately, across the board cuts to MA payment rates to hospitals do not have the same across the board impact.  Certain providers (like Children’s) see much higher numbers of MA enrollees than other providers, and so MA cuts hit them harder and they bear a disproportionate impact.  Helping lawmakers understand this disproportionality can help them think about ways to remedy or mitigate it.

While the cold reality is that sometimes, especially in tight budgetary times, legislators may not be able to fully address the concerns of high Medicaid providers, our goal is to continually help them to understand the impact of the decisions they make on child health so that they can make the best public policy possible for Minnesota.

Scott Leitz is the director of child health policy and advocacy at Children’s. Read more about him here.

Introductions: Scott Leitz

Scott Leitz As an unapologetic policy wonk and lover of health policy, I am honored and pleased to be blogging here.  I joined Children’s in December 2009 as our director of child health policy and advocacy.  Prior to joining Children’s, I spent over 15 years working on state health policy issues, most recently as Assistant Commissioner of Health in Minnesota, with responsibility for health reform.

In my years working in health policy, I’ve come to believe that regardless of the perspective you start with—physician, hospital, nurse, health plan, government official — there’s value in advocating your perspective and letting your views be known.  Not everyone is going to agree all the time, but unless we have ideas on the marketplace, we’ll never get good public policy.

I will be blogging about health policy and health reform issues.   The challenges facing our health care system are enormous:

• we still have too many Americans who lack health insurance
• health care costs that are too high and make insurance coverage unaffordable for many families
• quality of care is uneven and we don’t get the best value we could be for our health care dollars
• the way we pay for health care is fundamentally flawed, with little emphasis on prevention
• there are unacceptable disparities in health outcomes across racial and ethnic groups

Those challenges are what make this a daunting and incredible opportunity.

From the perspective of children, we’re fortunate in Minnesota to be starting from a place that most states would envy.  We have few uninsured kids than most states, our general population health is pretty good, and we get good health outcomes at relatively low cost.

That said, the opportunities for improvement are remarkable — there are tremendous and unacceptable disparities in health outcomes between children in different racial and ethnic groups, we’ve seen a steady increase in uninsured kids, our rates of teen pregnancy and STIs remain too high, and childhood obesity continues to increase.  We need to do better and Children’s can and should play a key role in this.

I look forward to sharing my thoughts with you, and I hope you will share yours back — just leave a comment below.  As in good public policy making, an open back and forth makes the best blogging.