The Hill News

As a pediatrician working in southeast DC, the Medicaid program means more to me than just fodder for heated budget debates on Capitol Hill.  Despite its imperfections, Medicaid is a lifeline of health and dignity for my patients and their families.

So when I hear talks of "tightening the belt" when it comes to federal spending, I don't see Medicaid as an expendable program. Yet, this belt-tightening metaphor is being used to justify support for proposed legislation like the State Flexibility Act (HR1683/S868), which lets states off the hook from maintaining Medicaid eligibility requirements for some of the country's most vulnerable populations. 

Belt-tightening is again invoked when other members of Congress describe caps to federal spending, under which many states' Medicaid programs would abandon children in order to balance their budget spreadsheets. 

Other politicians support funding Medicaid through block grants, but these simply grant states! permission to block children from Medicaid. All of these ideas are in the name of "tightening our belts," like a father tightening his belt to address the family's finances. To me, supporters of these ill-advised policies bring another metaphor to mind: a father taking off his belt and wrongly threatening his children for supposedly causing the family's financial problems.

All of us need to recognize just how much good Medicaid does for American children. Nearly all of my patients depend on Medicaid for their health care; in fact, 65 percent of DC's children are enrolled in the program. Nationwide, Medicaid and CHIP (the Children's Health Insurance Program) cover 30 million children, the majority of whom would be left without any health insurance at all if Medicaid went away.

With one out of three children across the country now relying on Medicaid, it is worth noting the program's remarkable efficiency. Children make up half of all Medicaid recipients, but acc! ount for just a quarter of the program's total costs. And cost! s of hea lth care per patient in Medicaid have grown slower than costs per patient with private insurance: 4.6 percent versus 7.7 percent per year. That is some serious bang for the taxpayer buck, which is all the more valuable as politicians evaluate our society's budgets.

This is not to say Medicaid is a perfect program. There is room for additional efficiency, and the Affordable Care Act has numerous provisions to cut down on waste, fraud, and abuse. But dealing with these problems requires a scalpel, not a hatchet. This social safety net is vital as our economy struggles to recover, and carelessly chopping at the program will create holes through which millions of Americans will fall. Proposals like the States Flexibility Act, block grants, or spending caps may sound like belt-tightening, but it comes at the expense of providing care for millions of children, disabled individuals, and our elderly.

I believe our members of Congress and DC's City Council support childre! n's health care, but too many times the children they speak of just exist in speeches about the deficit's consequences on future generations. The children I care for in southeast DC are real, not rhetorical. Almost half of the children there live at or below the poverty line, and the other half are just barely above it. My patients and their families are not strangers to challenging financial times. So when they hear about slashing their children's health care because politicians need to "tighten belts," it rings as hollow as "this hurts me more than it hurts you." 

When times are tough, my patients and their families have to do much more than tighten their belts. They pull together and look out for one another, they call on their families and communities for support, and because of Medicaid, they find ways to keep food on the table while also keeping their children healthy. Medicaid keeps many of the families I see from having to choose between buying groceries and ! taking their child to see me for a check-up.

As Congress! prepare s to tighten their belts and balance the federal budget, I urge them not to do so at the expense of our nation's children. We must keep Medicaid strong and protect all of our children's health.

Dr. Sanjeev Sriram is a pediatrician with Children's National Medical Center in Anacostia.