January 22_ 2009

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January 22_ 2009 Powered By Docstoc
					May 14, 2009

The Honorable Max Baucus
Chairman, Senate Finance Committee
U.S. Senate
Washington, DC 20510

The Honorable Charles Grassley
Ranking Member, Senate Finance Committee
U.S. Senate
Washington, DC 20510

Dear Chairman Baucus and Senator Grassley:

We are writing to thank you for your ongoing efforts to develop legislation to move our nation
on the path toward the day when everyone in America is assured access to high quality and
affordable health care. As an organization committed to ensuring that all of our nation’s children
are able to get the health services they need and deserve, we appreciate all of your efforts and the
efforts of your diligent staff – including Liz Fowler, David Schwartz, and Yvette Fontenot – to
develop a legislative proposal that includes meaningful coverage for all Americans.

As children’s advocates, we are concerned that issues related to children’s unique health concerns
have not been among the subject areas addressed during the series of hearings and meetings on
health reform topics hosted by the Committee over the last several months, including, most
recently, the roundtable sessions on Delivery System Reform and Coverage. We also have been
concerned that representatives from the children’s community have not been not invited to
participate on either of the committee’s roundtable panels. We appreciate this opportunity to
provide feedback on the committee’s recent policy options document, “Transforming the Health
Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs,”
because it allow us to provide important examples of how children could be left behind by health
reform if the committee does not directly address their unique needs.

First and foremost, we fully support your efforts to improve health care quality and to transform
existing health care delivery models to ensure improved access and quality, and ultimately patient
outcomes. However, we are concerned that children’s issues have not been properly recognized
or addressed in the policy options paper. Specifically, we were disappointed that children were
essentially left out of the initiatives and improvements that were proposed by the Committee,
including intiatives to improve health care quality and to speed the development and application
of health information technology systems through the Medicare reform. Because children
generally are not covered under Medicare, they will not benefit from such proposals. Congress
must ensure that initiatives – especially those related to quality and HIT – are also applied to the
programs in which children participate such as Medicaid and the Children’s Health Insurance
Program. There is much work to be done in developing child-appropriate outcome measures
and we are sincerely grateful to the Committee for its work during CHIP reauthorization to make
new strides in this key area. The same is true for using HIT systems to improve enrollment and
care coordination for children. We urge you to ensure that health reform builds on our successes
from CHIP and ensures that children also reap the benefits of these types of delivery system

In addition, we also wanted to comment on the Committee’s proposal to redistribute unused
GME slots to increase the availability of primary care services. While it is clear that lack of access
to primary care is a significant problem for many Americans both due to workforce shortages
and maldistribution of providers, in pediatric practice, the more apparent and pressing problem is
actually the opposite – a significant shortage of pediatric specialists. If the proposal in the policy
options paper to redirect GME slots to primary care is actualized, the shortage of pediatric
specialists would become even more profound because it would disincentivize pediatric specialty
training that often is financed through GME. Once again, as you develop legislative language, we
urge you to recognize the unique needs of children and ensure that Congress does not exacerbate
the specialist shortage that is already pervasive in pediatrics.

Children make up a significant portion of the U.S. population; they are one-third of the nation’s
non-Medicare population and their health care and developmental needs differ greatly from those
of adults. Children’s unique needs must be appropriately recognized and directly addressed in the
legislation that is currently being drafted if they are to benefit from health reform.

As you are drafting legislation, we urge you to keep the following principles in mind for children:
   Every child in America must have access to affordable, comprehensive, age-appropriate,
    child-focused benefit package that is appropriate to meet their age, health, and developmental
   No child should lose coverage or benefits as a result of health reform.
   Coverage must be simple, automatic, continuous and portable.
   System improvements must ensure high quality and performance for optimal maternal and
    child well-being.
   Health reform must recognize the essential role of safety net providers, including community
    health centers and school-based health clinics, as critical access points to care for millions of
    our nation’s children and their families.

We appreciate your long-standing commitment to our nation’s most precious resource, our
children, and we welcome the opportunity to work with you in the coming days, weeks, and
months to ensure that health reform meets the unique needs of children, indeed the needs of
everyone in America.


Bruce Lesley


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