A first look at insurance exchanges for pediatrics

Insurance exchanges and the Affordable Care Act (ACA) should mean greater access, agreed Anne Edwards, MD, and Michael McManus, MD, MPH, in a session titled “How will insurance exchanges work for pediatrics?” held on Saturday, October 26.

Edwards, chair of the Committee on State Government Affairs for AAP said, “It should mean opportunity for families to look at different insurance plans and obtain insurance in the marketplace.”

She continued, “We’re watching to make sure we interact with families to make sure they understand the insurance benefit packages and that they know that the cheapest plans may or may not be the best for children.” She added, “We really need to ensure that children within the programs have access to pediatricians and pediatric medical subspecialists.”

“There’s really no wrong door,” she commented. “If children are eligible for Medicaid or CHIP (Children’s Health Insurance Program) as they apply through the marketplace, they’ll be able to enter into those programs as well.”

McManus, attending of critical care medicine, Boston Children’s Hospital, and associate professor of anaesthesia (Pediatrics), Harvard Medical School, points to his experience in Massachusetts, which put together an exchange as a result of legislation in 2006. “There was a ramp-up period,” he explained, during which time people required a lot of education and assistance. “There was even some remedial legislation that was necessary at different points to tweak things, but it functions very well,” he stated.

“It’s important to expect a shakedown period,” McManus advised pediatricians. “It’s going take a little while to get things up and going and to have everyone aware of what’s going on.” He continued, “There’s a period where a lot of people are rushing in, and then there’s a quiet period where maybe people that should be connected aren’t, and they’ll need some help through that, but our experience here in Massachusetts is that after that initial period, things are fine.”