1. Opinion

Column: Raising the alarm on children's health care

Published Mar. 26, 2015

The ghost of systems past is haunting children's health care in Florida. Between Florida's system of Medicaid Managed Care and the nature of health plans offered on the Obamacare federal marketplace, kids are once again regarded as afterthoughts in health care.

Forty years ago, health insurance benefits and out-of-pocket costs were premised on the notion that children, for all practical purposes, were just "little" adults. Health insurance policies were developed for employees (adults) and their "dependents" (principally adult spouses and offspring, if any). Those health insurance policies were essentially blind to the unique health care requirements of children.

In the 1970s through the mid '90s, Florida policymakers recognized that medical services for children had become much more complex and specialized. Those advances in care were successful in dealing with children's genetic conditions as well as acute and chronic illnesses.

These policymakers also noticed that many, if not most, health insurance policies did not cover some of those specialized children's health care services. Indeed, most such policies did not cover habilitative services such as speech therapy for children, but would cover such services for adults in need of rehabilitation.

During that time, Florida's policy leadership recognized those concerns and created two solutions. One was a state agency called Children's Medical Services that was charged with organizing services for children with more complex and chronic problems. The other was a nonprofit called Healthy Kids Corporation charged with organizing and offering health insurance tailored for kids.

In both cases, the new organizations carefully assured that all products and services included providers appropriate to children's needs. The successes included children getting to the right provider at the right time, reducing the costly delays and mistakes by providers not trained or equipped to serve children, and bringing peace of mind and high satisfaction levels to parents.

Current state policy leaders seem to be on a track to dismantle both Children's Medical Services and Healthy Kids Corporation. The conditions requiring the establishment of those two organizations still exist, only in different form.

Not replacing those organizations with a functional alternative will put Florida's children back into the adult health care marketplace that they were rescued from by yesterday's policy leaders. The consequence of resuming the "kids are just little adults" policy changes may manifest as protests by parent advocacy groups and, most important, headlines describing awful outcomes of inappropriate children's medical care.

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The likelihood of these adverse outcomes is exacerbated by the fact that both Medicaid and to a great extent Obamacare rely on adult managed care companies as their "insurance products." Those insurance arrangements come with adult provider networks attached, with virtually no special attention to assuring that kids get the specialized services they need.

A policy solution that could avoid the impacts of these adverse changes would be to combine and restructure Healthy Kids Corporation and Children's Medical Services to create a children's health care marketplace, similar to and coordinated with Florida's adult health care marketplace. That would permit parents to obtain insurance plans and health care services appropriate for their children's needs.

A children's marketplace would develop sets of child-specific benefits, network standards and monitoring that would assure that kids get the right care at the right time from the right provider.

That would be a unique national model that policymakers could be proud of, as they were in 1996 when Florida won the Innovations in American Government Award for creating Healthy Kids Corporation.

Steve A. Freedman is professor emeritus in pediatrics and political science and director-emeritus of the Institute for Child Health Policy at the University of Florida. He wrote this exclusively for the Tampa Bay Times.


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