By Kelly Wolfe Director of Public Policy, Children’s Minnesota
Newborn Brayden Brorson seemed healthy and happy. He cooed and cuddled in his parents’ arms, and for his first few weeks things couldn’t have gone better.
Until they got worse. In a hurry.
Brayden began to go into distress. In a panic, his parents rushed him to the doctor. He soon ended up in the neonatal intensive care unit (NICU) of Children’s Minnesota’s St. Paul Hospital. Tests showed his kidneys were failing; more tests revealed a large mass.
Brayden, three weeks old, had cancer.
Fortunately, Brayden was at Children’s Minnesota, one of the largest pediatric health care systems in the region, with leading outcomes and pediatric services unmatched in depth and breadth. As one of the nation’s top 15 programs in the U.S. in both medical and surgical cancer outcomes, Children’s Minnesota is the largest pediatric cancer and blood disorders program in the Upper Midwest.
But there is more to Brayden’s story: As seasonal and temporary employees, Brayden’s parents did not have private health insurance. To treat the cancer, Brayden would need multiple operations, rounds of chemotherapy and scores of tests costing hundreds of thousands of dollars. How would his parents pay for his life-saving care?
Fortunately, Brayden’s parents qualified for Medicaid, the joint federal and state program that insures individuals with limited income, disabilities, or need for long-term care. As the largest health insurer of children, Medicaid is a vital program for families – in 2016 it covered almost 30 million kids in the nation and more than 600,000 Minnesota children. Medicaid covers well-child check-ups, doctor visits, medications, and treatments for common childhood maladies such as cuts, broken bones, coughs and colds, as well as life-threatening diseases like the one Brayden faced. Medicaid is also there for some of our most vulnerable children, premature babies.
The value of Medicaid is substantial. Medicaid has led to deep decreases in infant and child mortality rates. What’s more, Medicaid for children is as efficient as it is effective. Despite making up almost half of Medicaid’s enrollment, children account for only 20 percent of the costs. Research shows that children on Medicaid have higher educational attainment, better economic opportunity, and grow into healthier (and therefore less costly) adults than do children with no insurance at all. Clearly, investing in our kids’ health when they are young saves and improves lives, and saves money in the future.
But Medicaid, while a vital program, covers only a fraction of the actual costs of the care provided to pediatric patients in Minnesota. As often as not, that means the hospitals where Medicaid patients receive treatment underwrite much of the rest of the costs – in other words, they lose money.
Fortunately, again, Brayden was at Children’s Minnesota. Why? Because Children’s Minnesota never turns a child away.
Children’s Minnesota cares for more children than any other institution in the state, taking care of everyone who comes in its doors. Two of every three children in the Twin Cities who need hospital care go to Children’s Minnesota. What’s more, for many sick or injured kids, Children’s Minnesota is the only place to go. About 43 percent of the kids seen at Children’s Minnesota are on Medicaid.
Medicaid does not cover all of Children’s Minnesota’s costs, and we lose $82 million on Medicaid patients every year. By treating the most kids in Minnesota, and through the help of strong financial management and community philanthropy, so far Children’s Minnesota has been able to stay financially resilient, expand access and improve care. In addition, we have improved efficiency and health outcomes through care coordination models and innovative thinking. We are the first pediatric system leading a state demonstration pilot to improve quality of life for 35,000 kids on Medicaid.
Brayden underwent five surgeries, four rounds of chemotherapy, and many critical tests at Children’s Minnesota. Much of the costs of this treatment were borne by Medicaid and Children’s Minnesota.
Thanks to that treatment, Brayden beat his cancer. He is now a thriving five-year-old boy because his family was able to get the care he needed.
Today, our country is on the brink, yet again, of major health care reform. There are serious discussions at the state and federal level to contain the growth in health care spending by reforming our Medicaid system through increasing cost-sharing requirements, eliminating benefits, and capping funding. These changes could have devastating effects on Medicaid, pediatric health care and the kids they serve.
If Children’s Minnesota is to continue to treat every kid who walks in our doors and if our children are to lead healthy, productive lives, we need a strong and robust Medicaid program.
Our hope is that while on their mission to reform, policymakers keep sight of the best interests of our kids. If they do not, the story of the next Brayden could have a far less happy ending.