The Affordable Care Act and the PICU: How ObamaCare impacts children in the PICU
It’s the day after the drama surrounding yesterday’s Supreme Court decision upholding the ACA as constitutional. 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.