Featuring Dr. Ana Malinow, pediatrician and Clinical Professor of Medicine at University of California San Francisco: What’s more precious to our society than our children, our future? Yet today a growing number of children are losing health insurance coverage and as a result, access to health care. How does this impact them, and their families? Join host Brenda Gazzar as Dr. Malinow shares stories of young patients she knew and the sometimes devastating – even deadly – consequences they faced. Learn why children are losing their health insurance today, after the U.S. made substantial gains in coverage after the implementation of the Affordable Care Act. What can we do to make sure our children will never lose access to the care they need to survive and thrive?
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—– TRANSCRIPT —–
Opening (MUSIC – “Talk Back” 5 seconds, fade down)
Welcome to Code WACK!, your podcast on America’s broken healthcare system and how Medicare for All could help. I’m your host Brenda Gazzar. Today we’ll hear from a San Francisco pediatrician about the sometimes deadly struggles children and their parents face to get the health care they need. Enjoy the story.
What’s more precious to society than our children, our future? Yet millions of American children are uninsured – and that number is on the rise. Even those who do have insurance are vulnerable because high co-pays and deductibles can deter family members from seeking treatment right away. What’s the answer? And what can we as a society do about this?
(MUSIC – “Talk Back” 5 seconds, fade down )
— FEATURE —
Pediatrician Dr. Ana Malinow will never forget the story of Devante Johnson.
Devante died more than a decade ago of a treatable kidney tumor at the age of 14 after his health coverage had lapsed.
Here’s Malinow, who is also a clinical professor of pediatrics at the University of California San Francisco.
Malinow: Devante died because he was waiting to qualify for CHIP.
That’s a children’s health insurance program for those whose parents make too much to qualify for Medicaid and not enough to pay for private health insurance. In 2007, Malinow was the president of Physicians for a National Health Program, which advocates for single-payer health insurance like Medicare for All, when she met Devante.
Malinow: The BBC in the UK heard about this and they sent a reporter to Houston to interview the mother, and then they also interviewed me about this particular case, so I remember it very, very very vividly.
He was not a patient of mine but it’s a child that I did see and meet. And he was diagnosed with a kidney tumor and while he was on CHIP, was able to get health care, and then lost CHIP, because in those years, you had to reapply for CHIP and Medicaid. And if the parents didn’t have the paperwork filled out or for a myriad of other reasons or the parents made a tad bit above the guidelines, the child was no longer eligible and that’s what happened. He was no longer eligible.
While there are conflicting reports about some of the details, we know that Devante lost coverage for several months.
Malinow: And he was not able to get his chemotherapy and died as a consequence.
While the Texas teen was able to get coverage again before he died, it was too late.
Malinow: Every time, I give a talk I always start by dedicating my talk to Devante Johnson, who was a child that died of a highly treatable kidney tumor … because he was uninsured.
Do you think Devante would have survived had his coverage not lapsed?
Malinow: You know cancer is cancer, and we do everything possible for children with cancer and many, many, many children survive. The kind of cancer he had was highly treatable so I would say that if he had access to healthcare, he certainly would have had a fighting chance.
I’ve seen this firsthand happen to children who are not insured. Not only does it cause death but also unnecessary morbidity as well.
So for example, I took care of a newly diagnosed youngster with type 1 diabetes whose parents made a tad above the CHIP guidelines we were just talking about and they were facing selling the family farm to pay for their child’s insulin.
What happened?
Malinow: I was taking care of him at the hospital and he left the hospital so I’m not sure what happened with that. But the fact that the parents were forced with these kind of choices is awful. It’s awful.
While children have made great strides in coverage under the Affordable Care Act, they may not be long-lasting.
Largely due to the ACA, Medicaid and CHIP coverage for low-income working families rose from 53 percent to 79 percent between 2008 and 2016, according to Malinow. Other working families also saw large gains in the percentage of children covered under these programs.
This is important because children with such coverage are more likely to see pediatricians for preventative care, they go to the emergency room less and have higher rates of school graduation, she said.
Malinow: However, sadly, the Georgetown University Health Policy Institute just published some key findings which show in fact that the number of uninsured children in the U.S. has been increasing in the years from 2016 to 2018 … But they have been going down. So the number of children that are insured under these two policies — the Medicaid and CHIP — has been going down. So good news until about 2016 but bad news since then because more children are starting to lose coverage.
And why are they losing coverage?
Malinow: So they’re losing coverage because it’s becoming more difficult to qualify for Medicaid and for CHIP.
So they’re losing coverage because of stricter requirements in states for Medicaid and CHIP but also because more parents are losing their health insurance and for those two reasons, children are becoming more uninsured.
I mean, obviously, children depend on their parents, and if the parents have health insurance without any gaps then that’s good for children, but if the parents are experiencing any gaps, then those children experience gaps as well.
Got it. So what’s the impact of that?
Malinow: So the impact is huge because even while Medicaid can help uninsured children, we know that children who are uninsured actually are at risk for death.
So Devante died of cancer before the ACA was implemented. Do you think something like that could happen today?
Malinow: I think it certainly could because states still continue to have financial criteria that the parents need to meet in order to qualify. So the parents who make too much to qualify for CHIP or Medicaid but who are struggling to pay for private health insurance are the children that become uninsured.
We have uninsured children. We have them in California. We have them in many places in this country, and they are the ones who are falling through the cracks.
You know, I think it’s really important for us to remember that children are a part of the family and that even for them to have access to Medicaid or CHIP, their parents have to be working poor. Basically, we’re telling children that they have to be born into a family poor enough to be able to qualify for Medicaid or CHIP. These are the lucky ones. And how well can a parent parent if they are sick and don’t have access to health care? And we’ll talk a little bit more about this but the answer isn’t piecemeal. You have to cover everyone in a family, not just some people.
But even for families with private insurance, the picture isn’t great, Malinow said.
Malinow: Recently, I saw a patient for a two-year well visit. I could see that he had asthma, so naturally, i asked the mom about it and she refused to talk about asthma and I asked her why, and she said that last time, he was seen for a wellness visit during his 18-month well visit they talked about asthma and that she was charged $300 out of pocket for that, and why was that? Well, Because asthma or even talking about asthma is not covered as a well-child problem. So when the office charged for this conversation, the insurance company refused to pay.
The whole system is so disgraceful that it makes it hard to practice medicine…We talked about his asthma, we talked about his control and we talked about medications. Basically, I just didn’t document it so the patient wouldn’t be charged,
And this also happens to adults with private insurance, she said. What is the impact of this on patients and their families?
Malinow: The impact is obvious. If I can’t talk to a mother about this child’s asthma and about how we are going to control it and the medications that he should be taking, and about his triggers, and about his hospitalizations, and about the steroids he’s taking, then this child is at risk for having an asthma exacerbation, ending up in the emergency room, possibly ending up hospitalized, possibly ending up dead. These are huge consequences.
Are you having conversations with families that are concerned about cost?
Malinow: Yes, I am. I always tell them that the United States is the only country in the industrialized world that doesn’t have Medicare for All, and we’ll get to talk about Medicare for All and we start that conversation. Unfortunately, it’s not going to do anything about their health care bills right now.
I do think it’s important to remember again that children are part of a family, and anything that affects the family is going to affect the child and anything that affects the child is going to affect the family. Many pediatricians believe in CHIP and the sanctity of CHIP, thinking that, oh well if we just cover the children everything will be okay. The truth is if the family goes bankrupt due to medical bills, it will affect the child, if they lose their home due to medical bills, it will affect the child. If the parent is sick, can’t work and loses their health insurance, that will affect the child. To think that Medicaid and CHIP will help children is taking a very narrow view of the child.
In 2018, the cost of healthcare for a typical American family of four covered by an average employer-sponsored PPO plan was over $28,000 according to the Millman Medical Index. And overall, families will be paying more than $12,000.
Malinow: So that is going to affect the child, it’s going to affect the child as far daycare, school, aftercare, the soccer teams, the swim team, the kind of food they can put on the table, the kind of places they can enjoy to vacation. It takes a huge chunk of the family budget away.
And that’s money that can otherwise be spent on education, retirement savings, high quality food or a mortgage. So what’s the impact on their health then?
Malinow: So a lot of people decide not to seek healthcare because of their high deductibles and so they wait and wait and wait until maybe something that could be preventable is no longer preventable.
Or the mother of a 3-year old that comes in for a checkup but doesn’t want to talk about asthma.
Because it may cost her money that she doesn’t have. Why do you think Medicare for All is the solution?
Malinow: I think Medicare for All is important because it will cover everyone from conception to death, and we should not have any gaps at all, it should be comprehensive, it should cover all inpatient outpatient, it should cover prescription drugs, it should cover everything the child needs from a hearing exam to glasses. And it should cover the parents as well so the parents can be healthy and not have to worry about their own health, or if they happen to lose their job, that they’re going to lose their health insurance and then lose the child’s health insurance as well. And it should cover the grandparents and there should not be any need for Medigap and things like that because we know that seniors are paying thousands and thousands of dollars in out of pocket costs even while they do have Medicare. So we need to improve Medicare as well as expand it and improved-and-expanded Medicare will cover all pharmaceuticals as well as longterm care.
What’s at stake if we don’t have Medicare for All?
Malinow: Our current healthcare system leaves children vulnerable because they are vulnerable to the vicissitudes of our current healthcare system, which leaves many children out, and which makes parents pay an inordinate amount of their paycheck for health care. Health insurance is inextricably linked to a parents job, and if that parent gets sick, they can lose their job and therefore loses their health insurance, and then the child loses his or her health insurance as well
As a physician, my job is to be able to make kids healthy, and to keep them healthy and to prevent them from getting sick… and it’s very difficult to do that in an environment that is so caustic and so toxic to real health care. We live in a country that just allows children to die from a lack of health insurance, it allows their parents to die from a lack of health insurance. That is not a country that we should be proud of.
We should have access to health care, and we can, with Medicare for All, just like every other industrialized country, they have decided that healthcare for their children and their families and for everyone is very important it is attainable.
What can be done about this?
Malinow: It’s attainable. We have the Medicare-for-All Act. It’s in Congress. It’s something that can actually become a reality, and I think the sooner the better because people are dying and children are dying every year due to lack of health insurance.
How can you help change our broken healthcare system? First share this podcast episode with your friends, family and colleagues. Next, contact your congress members and urge them to support Medicare for All. Because let’s face it if you and I don’t stand up for our children’s health, who will?
(Music 5 seconds – Outro)
Well that’s it for today’s Code WACK!, a podcast by HEAL California. If you like what you’ve heard, please share, follow, and like us on Twitter and Facebook. Subscribe to our email updates at HEAL dash C-A dot org. This is a project of the California OneCare Education Fund. And I’m Brenda Gazzar.
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