Damian McNamara

November 08, 2013

ORLANDO, Florida — The American Academy of Pediatrics (AAP) wants its 60,000 members to help children and their families understand the benefits of the Affordable Care Act.

"Children already are better off because of the many consumer protections under the Affordable Care Act," Anne Edwards, MD, chair of the AAP committee on state government affairs, told Medscape Medical News. "As implementation continues, pediatricians will play an important role educating our patients and their families about the law and making certain that they receive the care they need."

Speaking here at the AAP 2013 National Conference and Exhibition, Dr. Edwards explained that "this is one of the most important years in implementation, and we need everyone involved." Although signed into law in 2010, "in many ways, the race has just begun," she said.

"Speak up, speak out, and share personal stories about how it helps patients and families, including the optional Medicaid expansion," Dr. Edwards urged. "The Affordable Care Act is really here to stay, but we need everyone working together to help make sure every facet of the law works."

Pediatricians play an essential role in helping patients and families learn more about the insurance options available to them, Dr. Edwards explained. Inform families they can choose a pediatrician as their primary care provider under the Act. In addition, "let them know that the cheapest plan might not necessarily be the best." Educate families to look for a plan, for example, that allows them access to pediatric specialists and subspecialists.

No Lifetime Coverage Limits

Already under the Act, 105 million children no longer have lifetime coverage limits to their healthcare coverage, an estimated 14 million children are receiving Bright Futures services without cost sharing, and 3.1 million young adults are covered by their parents' policies, Dr. Edwards pointed out. "Talk to your families about the considerable protections already in place for children, and talk to them about additional measures that will come into place for families in 2014."

According to a poll conducted in August by the Henry J. Kaiser Family Foundation, doctors and nurses lead the list of most trusted sources of information on the Affordable Care Act.

"Pediatricians can help dispel misperceptions about the law. Confusion abounds," Dr. Edwards said. For example, a USA Today/Pew poll conducted in September suggested that 53% of Americans oppose the law, "yet only 1 in 4 had any understanding of it and 1 in 3 did not know anything about it," Dr. Edwards said.

"We are in the middle of the most significant sea of changes in healthcare since Medicare and Medicaid, and pediatricians are leading the way forward for children," Dr. Edwards said. "With the Affordable Care Act, we are starting down a path where children might finally, truly have uninterrupted care throughout their lifetimes."

We are in the middle of the most significant sea of changes in healthcare since Medicare and Medicaid.

The AAP is also requesting feedback from pediatricians from both states where Medicare expansion is and is not underway. "If you live in a state that is not expanding Medicaid, unfortunately your state is at risk," Dr. Edwards said. "States will be passing up on $18.4 billion and leaving 3.6 million people uninsured by not expanding Medicaid."

"We can educate when we are educated," said Valeria Salinas-Sanchez, MD, a private practice pediatrician in Miami. "Until we know how this system will work, it is very difficult to think in terms of educating people about it," she told Medscape Medical News.

It would be helpful if the new health plans clearly outline the baseline benefits they cover, explain how different parties — insurers, the government, and patients — will contribute to the costs, and identify what the noncovered or optional services will cost people who want to pay extra. "Educators need to know what they are talking about and have a clear understanding of the choices before giving advice," she noted.

Dr. Salinas-Sanchez pointed out that time constraints could impede the ability of many pediatricians to decipher the new health plan options to the point where they feel comfortable offering advice to patients and families.

"They are expecting us to dedicate our time to figure this out." Dr. Salinas-Sanchez said she is already struggling to meet compliance criteria, deliver service with so-called meaningful use, and follow security regulations for electronic and communication systems in her practice. "We already have a lot to do in our offices," she said.

Feedback and stories can be sent by email to the AAP at ACAfeedback@aap.org.

Dr. Edwards and Dr. Salinas-Sanchez have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2013 National Conference and Exhibition. Presented October 27, 2013.

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