Last week House Republicans voted to cut benefits to the Supplemental Nutrition Assistance Program, or SNAP, slashing $39 billion in benefits over the next ten years in a vote of 217 to 210. All members of the Democratic caucus voted against the bill, which would affect 4 million people.
In June, fiscal conservatives squashed the Farm Bill that would have cut spending by $20 billion over ten years after determining the decrease was too meager. This new bill is their response to that. If successful, half of the cuts will put a stop to food aid after three months to people between 18 and 50 with no minors living with them if they are unable to find work, a move that makes little sense.
Poverty and health are inextricably linked, and food security plays a central role in this. Not only does poverty affect a family’s ability to buy food, it prevents them from buying healthy food. In the United States, lower income individuals are more likely to be obese, putting a strain on the healthcare system. Currently, beneficiaries of SNAP are eligible for SNAP-Ed, a nutrition education program designed to promote healthy eating on a limited budget. It is unclear how these cuts will affect SNAP-Ed.
African-Americans, no strangers to health inequalities, will be disproportionately affected by this change if successful. A new study shows that 90 percent of African-Americans benefitted from food stamps at one point or another in their lives. One in four African-American households faces food insecurity, and make up about 23% of all SNAP recipients.
“Speed kills,” warns the traditional highway sign about the dangers of haste and traffic deaths. Now, we know that stress kills, too.
Toxic stress, at any rate. The human body’s response to normal amounts of stress—say, a bad day at the office—is likely to be brief increases in the heart rate and mild elevations in hormone levels. But a toxic stress response, stemming from exposure to a major shock or prolonged adversity such as physical or emotional abuse, can wreak far more havoc.
In children, science now shows that toxic stress can disrupt the developing brain and organ systems.
The accumulated lifelong toll of stress-related hormones sharply raises the risk of chronic diseases in adulthood, ranging from heart disease and diabetes to depression and atherosclerosis.
Thus, the message from a panel of experts to the Robert Wood Johnson Foundation’s Commission to Build a Healthier America was at once simple and challenging: Create a healthier environment for—and increase coping mechanisms and resilience in—the nation’s most vulnerable and stress-ridden children and families.
At a June 19 meeting in Washington, DC, the commission heard testimony from a child development specialist, an economist, and community development professionals, among others. Together, they described more of the social and economic effects of toxic stress, but also the evidence that significant investments in individuals, families and communities can turn the tide.
One of the most remarkable talks I heard this year wasn’t about health care. It was about food. Of course, food is very, very closely related to health and health is at least tangentially related to health care.
So I invited Alan Greene of drgreene.com (who is a friend and has spoken at a couple of Health 2.0 Conferences) to tell me about the new book, Raising Baby Green. It really is a potential way to change how Americans (and everyone else) eat, and to use the most important years (the ones we can’t remember!) to do it.
Most importantly Alan is starting a viral campaign to get this information into the hands of expectant mothers. For anyone who knows an expectant mum or someone who might be one someday, this book is very important. And the message needs to get out and get mainstream quickly.
Here’s the interviewin which Alan explains how to feed kids right, and we do a little plotting in how to get this into mainstream child-raising.
In 2008, the number of uninsured children in the United States hit the lowest level in two decades. If Congress weren’t in the middle of a fierce debate on health reform, there would be time for everyone to celebrate a remarkable achievement and maybe even pause to reflect on how it was accomplished. To paraphrase David Byrne of the Talking Heads: “We might ask ourselves, how did we get here?” We got here with federal fiscal support, leadership, state ingenuity and a willingness to make a sustained effort to address the issue of uninsured children. The states deserve a lot of credit. It’s been impressive to see how state policymakers from across the political spectrum have rallied to support children’s coverage, despite facing tough economic obstacles in recent years. Even in the midst of terrible fiscal problems, the vast majority of states have maintained children’s coverage in Medicaid and CHIP. This year so far, a whopping twenty-three states found a way to expand or improve children’s coverage, proving what can be accomplished when the federal government is a strong fiscal partner.
Depending on who you listen to, health care reform in Washington is either closer to reality than it has ever been, or it’s on life support. Competing ideas are all over the map in terms of how health care should be delivered in America, and how we should pay the tab. About the only thing everyone seems to agree on is that the current system doesn’t work, and that we need to get something – anything – done.
But with all the energy and effort going into reform, getting “anything done” isn’t good enough. This is a chance to change the core values of our health care system to deliver access to high quality, low cost care. It’s time to “invest” in the health of our nation. We can’t settle for anything less.
As president and CEO of Children’s Hospitals and Clinics of Minnesota, my number one concern is the health of children, and I feel a responsibility to be a voice for children in this debate. The simple fact is, children don’t vote. They don’t have political action committees and they don’t make campaign contributions. But the decisions that elected officials will make about health care will have a huge impact on the health and well being of our children.
If we want to provide the best quality care for children, a few key principals must guide any and all health care reform decisions.
First, we need to address issues around Medicaid reimbursement. Medicaid is the single largest insurer of children in the country. In Minnesota Medicaid reimburses only around 80 percent of the cost of care, and in many other states, it’s less. In fact, for all the talk about poor Medicare reimbursement levels, Medicaid pays providers at rates 20 to 30 percent lower than Medicare. That’s why more and more doctors and clinics are declining to treat Medicaid patients, leaving families without access to proper care.
The current House bill recognizes this inequity and proposes to increase primary care physician payments under Medicaid to 100 percent of Medicare by 2012. However, it does not address inequities for other key providers such as pediatric hospitals and specialists.
At Children’s of Minnesota, we served more than 42 thousand children on Medicaid in 2008. We treat all children regardless of insurance status, but Medicaid reimbursement rates do threaten our ability to provide the kind of high quality, specialized services we believe children in our community deserve.
The second key element to reform involves a simple philosophy: we need to reward quality rather than quantity. My state, Minnesota, has a well-deserved reputation for delivering high quality, low cost health care. Because of this, our reimbursement rates are among the lowest in the country.
We are very concerned about any reform proposals that would apply across-the-board cuts to existing reimbursement rates, without taking into account the value of care already being delivered.
We need reform that provides incentives to caregivers to be innovative around efficiency. We should be rewarding providers who develop unique care models that eliminate waste while delivering excellent results. Only then will we see the cost savings that health care reform advocates are promoting.
Finally, we need to change the way we think about health care for children. Providing health coverage for all children should not be a luxury in this country. We have already acknowledged that every child has a right to an education, and as a society, we pay for it. Children’s health care deserves the same support. After all, the money we spend on children’s health is an investment that pays off for 70 or 80 years, not only in productive lives, but in avoidance of long term health costs. No other health care expenditure has that kind of return on investment. The needs of children must be front and center in this debate.
There are no easy answers for health care reform. Honest and thoughtful people can disagree on how we should go about changing the system. But by sticking to these core principals around Medicaid reimbursement, encouraging efficiency, and investing in children, we will have a good foundation to build on.
Alan L. Goldbloom, MD, is president and CEO of Children’s Hospitals and Clinics of Minnesota, the 7th largest pediatric health system in the United States. Previously, Dr. Goldbloom was executive vice president and chief operating officer at The Hospital for Sick Children in Toronto, Canada’s largest children’s hospital. After graduating in medicine at McMaster University in Hamilton, Canada, and training in pediatrics at Boston Children’s Hospital, Dr. Goldbloom practiced General Pediatrics and served as Director of Residency Training at both Dalhousie University in Halifax and at the University of Toronto, before becoming involved in hospital management.