How ObamaCare affects critically ill children

The drama surrounding the Supreme Court decision upholding the ACA as constitutional has ended. As legions of reporters and bloggers have written, the law has far-reaching effects. In my corner of medicine it will greatly help (already has, really) a small but not insignificant number of children and families. These families are those who have a child with a severe chronic medical condition.  Many of these these children spend time in the PICU. This is because they are fragile little people, and the least bump in the road can make them very ill very fast. A good example would be a child with severe respiratory problems such that he requires a tracheostomy and a home ventilator. When a child like that gets a simple cold he can deteriorate very quickly and wind up in the PICU for a few days at least.

I’ve written before about how the percentage of children in the PICU with Medicaid is much higher than it is for children in general. There are several reason for this. One is that children from poorer families are just more likely to become critically ill. People debate why that is so, but surely a key reason is that their access to care is not optimal, so things requiring ongoing care (asthma or diabetes, for example) don’t get taken care of until the child gets very ill and they land in the PICU.

There is another reason so many of these medically fragile children are on Medicaid. Until the ACA, a child could be booted off his family’s health insurance policy if his lifetime medical costs reached a cap set by the policy. What happened then? Or what happened in the not uncommon situation in which the family changed insurance policies, say from a change in jobs? If the parents were obliged to buy their insurance on the open market, common among self-employed people, their child’s “pre-existing condition” (a horrible term) would make it impossible to get insurance coverage for him. Then what? A common approach was to apply to the Social Security Administration to get the child labeled as disabled and qualify for supplemental security income support. If the family could accomplish that, a process that can take years, Medicaid coverage comes automatically. If not, then the family had very few choices. Some went bankrupt. I have seen that happen.

The previous system, in effect, allowed insurance companies to off-load children onto the public system who were expensive to the company; it limited their exposure. That’s not what Medicaid was designed to do, and it’s not fair to the family or to the rest of the public.

So whatever else the ACA does, it makes life much easier for many children I treat and their families.

Christopher Johnson is a pediatric intensive care physician and author of Your Critically Ill Child: Life and Death Choices Parents Must Face, How to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments.  He blogs at his self-titled site, Christopher Johnson, MD.

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  • Michael Mank

    Thank you for this article and for bringing light to a patient population I have rarely read about.

  • John Key

    Your glory, laud, and honor to Obamacare may be premature. What you are really praising here is a system of cost-shifting from one group to another group. It all seems very humane and egalitarian, but the dual realities of “there’s no free lunch”and “somebody has to pay for it” cannot be avoided. I doubt that the care received by the infant will be very different; OTOH maybe it is great to help families avoid bankruptcy, maybe it isn’t. The bills still have to be paid from some source.

    Helping people avoid personal financial responsibility may be wonderful. Personally i’m not so sure.

    • Molly_Rn

      We all pay for the poor who are forced
      to go to the emergency department for their care and it is very expensive. It
      is cheaper to help them get healthcare and have a primary doctor who can care
      for them at a less expensive rate. There is no free lunch and we all pay one
      way or another. If we have a healthy citizenry, than they can work and be
      taxpayers. I sure hope those of you who have no sympathy or empathy for those
      less fortunate than your selves are not physicians or nurses, because I would
      not want to be your patient.

  • asierra45

    Good for you! Dr. Johnson, poverty and parents that lack resources for education and could be away from extended family and friend have kids that are more prone to land in your PICU. They are a treasure top this Country and really deserve better care and the system tending a hand to them and their parents. Will follow you from now on.

  • Stephen H. Johnson

    What Dr. Johnson is praising is not “cost shifting,” which as his article points out, will always occur, but institution of a cost sharing system that is both more rational and more humane than the current one

  • Molly_Rn

    It is not Obamacare (this is a putdown or should I say slam) it is correctly the ACA or Affordable Care Act. It helps us all by eliminating the “previous condition” prohibiting us from getting healthcare insurnace, stopping the cut off of healthcare due to an arbitrary amount of dollars set by the insurance company, letting young adults stay on their parents health insurance, etc. It may not be perfect, but it is a good start.

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