Pub H CONTENTS Hearing held in Washington, DC, May 5, 1992...... Brown, Sarah S., M.P.H., senior study director, National Forum on the Future of Children and Families, Institute of Medicine, National Re- search Council, Washington, DC. Haislmaier, Edmund F., policy analyst for health care issues, the Herit- age Foundation, Washington, DC... Johnson, Robert L., M.D., FAAP., director, division of adolescent medi- cine, UMDNJ-New Jersey Medical School, Newark, NJ, and chair of the board-The Center for Population Options, Washington, DC.. Nelson, Richard P., M.D., president, Association of Maternal and Child Health Programs, director, Child Health Specialty Clinics, and associ- ate professor of pediatrics, University of Iowa, Iowa City, IA.. Renshaw, Kathleen, parent accompanied by Marisa Harvey, Encinitas, Weaver, Joan and Mike, accompanied by Steven Weaver, Lorton, VA ........ Prepared statements, letters, supplemental materials, et cetera: American Academy of Pediatrics, Washington, DC, prepared statement of Barrett, Hon. Bill, a Representative in Congress from the State of Ne- braska, prepared statement of. Bilirakis, Hon. Mike, a Representative in Congress from the State of Florida, prepared statement of. Brown, Sarah S., M.P.H., senior study director, National Forum on the Future of Children and Families, Institute of Medicine/National Re- search Council, Washington, DC, prepared statement of. Feldman, Margaret, Washington representative, National Conference on Family Relations, 1992 coordinator, Consortium of Family Organiza- Freedman, Steve A., Ph.D., F.A.A.P., (Hon.) executive director, Institute for Child Health Policy, associate professor of pediatrics and health services administration, University of Florida, Gainesville, FL: "Sounding Board, Coverage of the Uninsured and Underinsured" article entitled, from the New England Journal of Medicine, March Griss, Bob, senior health policy researcher and co-chair, health task force, Consortium for Citizens with Disabilities, United Cerebral Palsy Asso- ciations, prepared statement of. Haislmaier, Edmund F., policy analyst for health care issues, the Herit- Response to questions posed by Congresswoman Patricia Schroeder..... Johnson, Robert L., M.D., F.A.A.P., director, division of adolescent medi- cine, UMDNJ-New Jersey Medical School, Newark, NJ, and chair of the board-The Center for Population Options, Washington, DC: Letter to Congresswoman Patricia Schroeder, dated May 29, 1992, 79 203 Page Prepared statements, letters, supplemental materials, et cetera-Continued Letter to Chairwoman Patricia Schroeder, dated June 4, 1992, with Prepared statement of. Renshaw, Kathleen, parent, Encinitas, CA, prepared statement of... Health Care Reform: How Do Women, Children, and Teens Fare? a 194 57 13 4 Letter to Richard P. Nelson, dated May 21, 1992, requesting answers Letter to Edmund F. Haislmaier, dated May 21, 1992, requesting 201 193 Opening statement of.. Letter to Sarah S. Brown, dated May 21, 1992, requesting answers to Letter to Robert Johnson, M.D., dated May 21, 1992, requesting an- 196 219 2 Sweeney, Robert H., president, the National Association of Children's Hospitals and Related Institutions, Inc., Alexandria, VA, prepared statement of... 136 Walizer, Elaine H., Chagrin Falls, OH, prepared statement of 128 20 HEALTH CARE REFORM: HOW DO WOMEN, CHILDREN, AND TEENS FARE? TUESDAY, MAY 5, 1992 HOUSE OF REPRESENTATIVES, SELECT COMMITTEE ON CHILDREN, YOUTH AND FAMILIES, Washington, DC. The committee met, pursuant to call, at 9:30 a.m., in room 2226, Rayburn House Office Building, Hon. Patricia Schroeder (chairwoman of the committee) presiding. Members present: Representatives Schroeder, Lehman, Martinez, Evans, Durbin, Sarpalius, Peterson, Cramer, Jr., Wolf, Holloway, Smith, Walsh, Klug, and Barrett. Staff present: Karabelle Pizzigati, staff director; Jill Kagan, deputy staff director; Madlyn Morreale, research assistant; Carol Statuto, minority deputy staff director; Elizabeth Maier, professional staff; and Joan Godley, committee clerk. Chairwoman SCHROEDER. Let's begin this morning. I want to thank you all for coming. We are very excited on the select committee because for the first time in 20 years we see serious discussions about health care going on in the United States and Congress. And there are dozens of bills. There is kind of a fast bill breeder reactor, kicking out more and more health care bills. And we also see lots of states trying very hard to figure out what to do. What this committee wants to do is monitor what is being done and make sure that women, children and teens don't get lost in the shuffle. Very often those voices are not heard here. And we certainly don't want to end up finding out that the Congress has adopted something and then it is, oops, look at the oversight, we forgot to do this. I think that any kind of health care that we adopt, whether it is employer-based, single-payer, or grounded in the tax system, must be sure that we are dealing with preventive care and we are dealing with families in a much fairer way. We know the financial barriers that have been out there for many families. We know that 12 million children and adolescents and 9 million women of childbearing age have absolutely no health insurance. And then you add to those numbers a significant number of millions of people who have inadequate insurance. So we see those in the private sector competing for more and more overworked staff and inaccessible clinics, and states that are squeezing their pennies very tightly. And so it becomes a very difficult problem. (1) We also have been looking in this committee at mental health problems and making sure that those be included, especially vis-avis adolescents. Our last hearing was very discouraging because we found that we had for some adolescents absolutely no mental health care, actually for a large majority of them. And then for some of those who had any health care at all, there were a few who were being abused by the mental health care system. So the question is how we make sure that all of those areas are included, also incorporating help for families to care for children who have disabilities or chronic illnesses at home. We also find it amazing that people get locked into jobs and can't move because of their insurance or that they have to choose between poverty or marital break-up to find some way to get the proper insurance for their families. All of those seem absolutely nuts to us. I could go on and on and on with the different things that we have uncovered as we listen to people. But I think what we have today here are some very good experts who have been studying it, and we are looking forward to hearing from them. And we are going to lead off with some families who have been feeling it and we will have the people who felt some of the discrimination. And then we will have some of the experts talking about what to do. So I think it will be an interesting hearing and this record will certainly help the select committee evaluate the different programs this body will be taking up. OPENING STATEMENT OF HON. PATRICIA SCHROEDER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF COLORADO, AND CHAIRWOMAN, SELECT COMMITTEE ON CHILDREN, YOUTH, AND FAMILIES For the first time in 20 years, the nation has begun serious discussions about major health care reform. While action to date has been stymied over which approach to take, there are dozens of bills in Congress improving, modifying or discarding the current insurance system. Several States, despite serious financial constraints, are enacting their own statewide health insurance reform. But as the debate progresses, my fear is that women, children, and especially teens will get lost in the shuffle. I am especially pleased that with this hearing, the Select Committee begins an exploration of the special problems of women, children and teens in gaining access to health care. The goal is to ensure that any health care policy that moves forward—whether it is employer-based, single-payer, or grounded in the tax system-knocks down the barriers that still keep so many from receiving the care, especially the preventive care, they need. Financial barriers, including lack of health insurance, are by far the most common and significant reasons that women and children don't get adequate care. Twelve million children and adolescents, and nine million women of childbearing age, have no health insurance, and millions more have inadequate insurance. There are other barriers keeping children and families out, even when they are trying their hardest to get the best possible care, including services that are unfriendly and often demeaning, inaccessible clinics with overworked staff, a critical shortage of private primary health care providers, a crumbling public health system, and bureaucratic hassles. Under the current system, even families with health insurance don't get the basic preventive care they need, because many insurance policies won't cover immunizations or well-child doctor visits, or even maternity care. Substance abuse treatment or mental health services for teens are not only in short supply, but private insurance often won't cover those services either. And families struggling to care for childen with disabilities or chronic illness at home, are often forced to choose between poverty, institutionalization, or marital break-up because of limitations in their insurance policies. Add to this maze the growing complexities and social ills that afflict millions of children and teens across the nation. High infant mortality and shockingly low childhood immunization rates warn that the system is in crisis. AIDS, violence, and drug addiction terrorize our youth and add further stress to the current health care system. How do most of the current health care reform proposals in Congress address these concerns? Is a universal insurance system alone sufficient to ensure access to care for women and children? Do these proposals also sufficiently ameliorate or eliminate all of the obstacles that prohibit children, teens and families from getting the care they need? These are among the questions the Select Committee will attempt to answer today. I welcome the experts who have already compiled the criteria we need to evaluate the major reform proposals under consideration by the Congress and the states and look forward to their testimony. I especially want to welcome the families who have confronted the system head on and been forced to retreat-and their families have suffered as a result. Their stories should motivate us to take immediate action. No one should have to endure undue hardship just to obtain medical or support services for themselves or their children. Other nations have demonstrated that it doesn't have to be this way. No pregnant woman in Europe has to ask how or where she will receive prenatal care or who will pay for it. Immunization rates among infants in countries like Botswana and Brazil far surpass what the U.S. has been able to accomplish. And, compared with our friends in Europe, we fall far short of offering families in need support services such as respite care or home visiting. We already know that the U.S. is the only industrialized nation, other than South Africa, without a family leave policy that allows parents time off at the birth or adoption of a child, or to care for a seriously ill child. I welcome all of you here today and look forward to your testimony. But most of all, I look forward to putting this information to good use in the pursuit of a health care reform policy that really works for children and families. |