Pediatricians warn of looming crisis in caring for poor children

Pediatrician LeLoch Rave let KIRO 7 look in as she saw a young patient at the Everett Medical Clinic in Mukilteo.   For years, many of her patients were poor children on Medicaid.

But the Everett Clinic was losing $5 million a year taking care of them. 

"And so, in the summer of 2015, the Everett Clinic closed its doors to new Medicaid patients," said Dr. Rave.

There are exceptions. Current patients as well as foster children may still go there.

"But if you happen to be just a family out on the street and you're starting your family anew and you have a new baby," Dr. Rave said, "Unfortunately, the Everett Clinic is not an option for you now."

The Everett Clinic is not alone. The Vancouver Clinic decided also it could no longer accept young Medicaid patients because they simply couldn't afford to.  Where do those poor children often end up for medical care?

Often, a local emergency room.

And that can have devastating consequences.

"We had a physician report to us that a child had waited months for primary care and their eczema looked like burns," said Sarah Rafton.

Rafton runs Washington state's chapter of the American Academy of Pediatrics.  She says one in every two children in this state is poor and on Medicaid. But what the state pays for Medicaid is not keeping up with the cost.

"The reimbursement for Medicaid is about two-thirds for Medicare and about 60 percent of private or commercial insurance," Rafton said.

The state pays $156 for a poor adult on Medicare, but less than half that amount when a poor child needs to see the doctor.

"Are they going untreated?' Rafton was asked.

 "I would say there are kids who are experiencing significant delays in getting treatment," Rafton replied.

To fix that, Rafton says, the state needs to pay pediatricians the same as they pay doctors for adults. That would add an estimated $7.5 million to the state's current Medicaid/Medicare budget of $4 billion.  Rafton believes that is a small price to pay for healthy children.

"And also the data bears that out," Rafton said. "That it's cost effective to make this modest investment in early and preventive care for kids."

But the state legislature sets Medicare and Medicaid rates. And so far, legislators have not budged.

"What's been the problem with getting the money?" she was asked.

"Well, our legislature faces some very significant budget challenges," Rafton replied.  "I think the message has resonated. And I think our policy makers understand and believe it. But now comes the prioritization with a pretty big budget gap to fill."

Dr. Rave and her colleagues at the Everett Clinic have been living with the decision not to accept new Medicaid patients for about a year now.  But it still rankles.

"We, in many ways, shortchange kids in our society," she said. "We don't pay teachers very well. We don't fund our education system adequately.  We're seeing here an example of not funding medical care adequately."

And all of us are the losers.

Advocates say they plan to try again in 2017 to persuade the state legislature to increase the funding for medical care for poor children.

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