Advocating for Children: Interview With Dr Fernando Stein

Editor's Note:
Subsequent to this interview, the AAP released a statement opposing the American Health Care Act (ACHA) which is currently being debated in the House of Representatives.

Hansa Bhargava, MD: Hello. I am Dr Hansa Bhargava, a practicing pediatrician, senior medical correspondent for Medscape, and senior medical officer for WebMD. Today, I have the pleasure of hosting Dr Fernando Stein, the president of the American Academy of Pediatrics (AAP), to discuss some very important issues. Dr Stein, thank you for being here and welcome.

Fernando Stein, MD: Thank you.

Dr Bhargava: Would you tell us a little bit about your background?

Dr Stein: I was born in Guatemala and went to medical school there. In the late part of 1975, I moved to Houston, Texas, where I did my residency in general pediatrics and critical care. I remained there until recently when I assumed the presidency of the academy.

Dr Bhargava: We are really excited to have you here. We will be discussing a few issues that have been elevated by the AAP that are very important and relevant to what is going on in medicine today.

Healthcare for Children

Let us talk first about the Children's Health Insurance Program (CHIP). Congress returned to Washington the week of April 24 following a 2-week recess. Although the American Health Care Act (AHCA) did not pass the House, it does seem to be on the radar for the Trump Administration. The AAP is focused, at the moment, on extending funding for CHIP, which expires in September, and continues to urge Congress to keep Medicaid strong for children. Can you briefly describe the impact of CHIP on children's access to care?

Dr Stein: Nearly 9 million children are enrolled in the CHIP program. Thanks to CHIP working hand in hand with Medicaid, children are having fewer issues with insurance, and, as we speak here today, more than 95% of children are covered by one form of insurance or another. The AHCA would drastically curtail that level of coverage.

Dr Bhargava: There has also been some discussion about subsidies, with tweaking of the Affordable Care Act (ACA) and possible elimination of subsidies, which could possibly result in higher insurance deductibles. Would that affect children as well, Dr Stein?

Dr Stein: Yes. Children are not little adults. There are certain issues related to Medicaid that are interesting. For example, in absolute numbers, about 50% of users covered by Medicaid are children. They represent about 20% of the expense. That is a good investment. Some changes being suggested would change that. In addition to the bills proposed to cap Medicaid funding, the amendments proposed would essentially eviscerate existing protections that afford children and pregnant women the appropriate coverage that they need.

Dr Bhargava: How could that affect the immunization programs that exist currently?

Dr Stein: Immunization programs are covered by a variety of local, federal, and state sources. The issue of immunizations appears to be more legislative than of actual implementation. It is not so dependent on funding.

Advocating for Children

Dr Bhargava: What has the AAP been doing to educate legislators and the public about concerns with replacement or tweaking of the ACA?

Dr Stein: In short, we have been doing a lot. We partnered with other medical organizations that represent primary-care physicians: the American Congress of Obstetricians and Gynecologists, the American College of Physicians, the American Academy of Family Physicians, and the American Osteopathic Association. Between the five organizations, we represent 500,000 physicians. We have been to Capitol Hill several times. The first time we went, we had a press briefing before we went in. One of the reporters asked me, "Whose ear do you think you have, Dr Stein?" My reply was, "We have the ear of our patients." You do the numbers. If there are 1000 to 2000 patients per physician and 500,000 physicians, we have the potential for reaching 100 million people.

Dr Bhargava: That is excellent and so important. It is obvious and clear that the AAP will continue to monitor any and all legislative efforts. The work you all have done that affects healthcare coverage is incredible. What do you suggest that pediatricians do on an individual basis to advocate for children?

Dr Stein: The pediatrician needs to respond to the needs of children, and we have to be where our families are. Pediatricians need to reach out to their patients. We need to be advocates for the rights of children. That can be done not only through social media but by getting engaged in community efforts and speaking up for children whenever we have the opportunity to do so.

Dr Bhargava: I will play devil's advocate here for a second because our audience is physicians. As you know, they are extremely busy in practice. What can we do to make sure legislators listen to the needs of children?

Dr Stein: Pediatricians are welcome in the halls of Congress. I was really skeptical when I was first asked by the academy to go and speak on behalf of the profession and the patients we serve. We had a fly-in with 150 pediatricians and visited the offices of over 50 members of Congress. We were very welcome, not only because we represent children, and children really have no enemies, but also because we approached members of Congress in tandem or in coordination with the other medical organizations representing, as I said, 500,000 physicians.

Dr Bhargava: Thank you, Dr Stein, for joining us today.

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