"Access is at the top of everyone's agenda," stated Dr. John E. Lewy, FAAP, chair of the American Academy of Pediatrics' Committee on Federal Government Affairs. With more than nine million uninsured children in America, many kids go without the necessary preventative medicine … and even acute care … that they need. In the 109th Congress, the AAP supports several solid pieces of legislation that would significantly chip away or totally eliminate the number of uninsured minors in the nation. While advocating for broad-based access to healthcare, the AAP is simultaneously trying to minimize damaging cuts to the nation's Medicaid program. With $10 billion in cuts slated over the next five years, the AAP fears that both enrollment and benefits will be impacted further elevating the number of children who don't get appropriate medical care in the United States. Lewy, who is a professor and chairman emeritus of pediatrics at Tulane University Health Sciences Center, said protecting entitlement and maintaining services for young patients is paramount. "Medicaid has very appropriate benefits including EPSDT (Early and Periodic Screening, Diagnostic, and Treatment), which is a mandatory benefit and a very important benefit," the pediatrician noted, adding that keeping this in place is a key concern. He and colleagues at the AAP have already met informally with several congressional leaders to voice these concerns and share ideas, and they have offered to provide direct testimony to the committees in charge of finding "savings" in the program. The AAP was a staunch supporter of the new Medicaid Commission in its original form while it enjoyed broad bipartisan support and had the participation of governors. That, however, has changed since it became apparent the commission's two main tasks would be the massive short-term cuts and eventually long-term reform. "The Academy still supports the concept of the Medicaid Commission but is concerned about the way it is evolving," Lewy said. "We don't feel there should be any cuts," he continued, adding the $10 billion is an arbitrary number agreed upon as a compromise between the Senate, which wanted no cuts, and the House, which wanted $20 billion in cuts. The AAP would still like to work with the Medicaid Commission on finding true, long-term solutions to reform the nation's healthcare program for the poor. The pediatric organization would like to see savings come from gained efficiencies in the program rather than cuts in service or by further eroding enrollment. Instead, the AAP would like to see more children, particularly those whose families don't qualify for Medicaid, have access to healthcare. Lewy said the most promising bill to eliminate barriers to access is the MediKids Health Insurance Bill. The bill was introduced in the last Congress by Senator Jay Rockefeller (D-West Virginia) and Congressman Pete Stark (D-California) and will soon be reintroduced to the 109th Congress. "It is an umbrella," Lewy explained. "In MediKids, when you're born or upon acceptance as a legal immigrant in the country, you are ensured insurance in one form or another." The bill doesn't seek to eliminate current programming such as employer-based health insurance, Medicaid or CHIP programs. Children in those programs would remain there. However, it does seek to bridge the gap for the nine million that don't fall into any category. "What MediKids does is fill in the blanks and assures 100 percent of children would have insurance with good benefits," Lewy continued. The safety net program calls for reimbursement to physicians at a level no lower than Medicare rates. "The Academy of Pediatrics really feels MediKids is the best answer for today to ensure all kids have access at reasonable reimbursement rates," Lewy said of the "win/win" legislation. However, he and his colleagues are very aware that MediKids, which never made it to the floor for a vote in the last Congress, might not come up again. Therefore, the AAP also supports other incremental bills that, while not as broad sweeping as MediKids, would begin to chip away at the number of uninsured. The Kids Come First Bill, introduced by Senator John Kerry (D-Massachusetts), would insure children up to 300 percent of the poverty level. Lewy explained that the bill would require states to provide coverage for children between 101-300 percent of the poverty level at the current state/federal match rate. If they did this, then the federal government would completely pick up the cost of covering children up to the 100 percent poverty level. "The thought is most of the uninsured not eligible for Medicaid or CHIP are between the 200-300 percent poverty level," said Lewy. Other bills on the table, such as the Children's Express Lane Bill and The Family Opportunity Act, also provide some relief. The Express Lane Bill says that if a child qualifies for one federal program, then they would automatically be deemed to be eligible for others with the same eligibility requirements. For example, with interconnected eligibility if a child qualifies for the School Lunch Program, then they would be qualified for Medicaid. "This is very good because this gives flexibility to enrolling children in Medicaid and CHIP," said Lewy, adding that it streamlines the process and eliminates having to go through the cumbersome enrollment procedure multiple times in order to receive multiple services. The Family Opportunity Act provides coverage for children with special healthcare needs up to 250 percent of the poverty level. "Each of these is trying to chip away at the uninsured whereas MediKids does the whole thing," Lewy noted. However, he added, all of these incremental bills are compatible with MediKids since the latter is designed to fill in any gaps in coverage. Lewy said the AAP would be pleased to see all of these bills become law. Conversely, the AAP would be disappointed if the bill on the table for association health plans were enacted. In its current incarnation, the bill calls for no state insurance regulation of these health plans. "The Academy is for the idea of group health plans but is against the current associations health plan," Lewy stressed. "But," he added, "we hope Congress will come up with an associations health plan bill that will include state oversight." Most states, he noted, have some minimum benefit requirements in place. Although current legislation is favored by small businesses, Lewy and colleagues are worried that the lack of oversight will allow these plans to offer little or no benefits simply to be inexpensive.