By Marion Davis
For 14 years, Elizabeth Burke Bryant has worked to improve local children’s lives by gathering, analyzing and disseminating data to help identify problems, show the impact of public-policy choices, and educate state leaders and the general public.
As executive director of Rhode Island Kids Count, she’s both an advocate and an expert voice at the Statehouse, known for emphasizing the positive – the gains from investing in children’s health care, for example, and the potential rewards for additional efforts.
In this vein, on Oct. 19, Kids Count held its ninth annual Celebration of Children’s Health, citing progress in prenatal care, children’s preventive care and more, and urging policymakers to avoid cuts to RIte Care, the Medicaid program for children and families.
Bryant answered questions about children’s health, Medicaid and health care reform.
PBN: You hold these Celebration of Children’s Health events annually. Who is your target audience, and what do you hope to accomplish?
BRYANT: Our goal is to maintain and build support for children’s health coverage as a key public policy priority. Our target audience is legislators, elected officials, state agency staff, and other community leaders who work in children’s health. We highlight the gains that Rhode Island has made and recognize key leaders for their support, including elected officials and community leaders. The event is an opportunity to provide an annual update on progress toward the goal that all Rhode Island children have the health insurance coverage they need for healthy development and good physical and mental health.
PBN: How big a factor is RIte Care in the successes you’ve documented over time?
BRYANT: RIte Care has been essential to Rhode Island’s success in achieving high rates of children’s health coverage. While two-thirds of children in Rhode Island are covered through employer-sponsored health insurance, RIte Care has played an important role by offering low-income uninsured working families a way to get affordable, high-quality health insurance coverage for themselves and their children. RIte Care has a strong and well-documented history of producing positive health outcomes for infants, children, pregnant women and parents. These outcomes save our health care system money. RIte Care provides the kinds of primary and preventive care that children and families need to stay healthy. Research shows that insured children are more likely than uninsured children to receive preventive care and have a regular health care provider. They are also more likely to receive treatment for conditions such as asthma and ear infections that, if left untreated, can have lifelong consequences and lead to more serious and costly health problems.
PBN: What is it about RIte Care in particular that works so well? Your figures seem to suggest that it’s not just that it covers families, but the structure of the health plans.
BRYANT: What works well for RIte Care is the managed-care approach we have chosen to use. We have three high-quality health plans available that all consistently rank in the top 10 on quality ratings for Medicaid managed care plans nationally. They have strong networks of providers in Rhode Island and high ratings for member satisfaction.
The R.I. Department of Human Services, which oversees RIte Care, carefully identifies patient care and patient satisfaction outcomes that the plans must meet, actually measures them, and holds the plans accountable for achieving them. This doesn’t happen in many other states. In Rhode Island, coverage means that kids get the care that they need to be healthy. Also, Rhode Island covers income-eligible parents as well as their children. Research shows that children in families in which the parents also have coverage are more likely to access preventive health care and have better health outcomes overall.
PBN: Children’s health insurance coverage peaked at 96 percent in Rhode Island in 2002 and has declined to about 93 percent, though it’s leveling off. What has driven that trend, and what do you think can be done about the fact that 72 percent of the state’s 17,000 uninsured children are income-eligible for RIte Care, but not enrolled?
BRYANT: There are many factors involved in the trends, [including] a significant decrease in access to affordable employer-sponsored coverage … and a variety of administrative barriers put in place for RIte Care in recent years that makes it more difficult for families to apply for coverage and to stay enrolled. …
Our goal is that all children in Rhode Island have the health insurance coverage they need so that they can access high-quality health care. We continue to work with state and community leaders to do the work of finding families who are eligible and making sure that they get enrolled and stay enrolled, so they do not have gaps in access to care. ...
As part of a federal requirement, the state funds the Family Resource Counselor network to provide application assistance to families. But more needs to be done to find and enroll families who may not know they are eligible. It is up to all organizations who work with families [to help]. ... We [also] know that the RIte Care premiums may be difficult for some families to afford and that there are administrative barriers. … Rhode Island is working to improve access to benefits by modernizing the application process.
PBN: At the event, you recognized U.S. Sen. Jack Reed for his work on behalf of children. What are some of his most valuable contributions, and how big a role do you see for the federal government in ensuring all children have health care coverage?
BRYANT: Sen. Jack Reed is one of the most well-respected senators [and] holds many key leadership positions, … and he has consistently provided national leadership on children’s health coverage. The federal government has a vital role in addressing children’s health insurance issues, as evidenced by the reauthorization of the Children’s Health Insurance Program this year. Sen. Reed is to be commended for his role in that and for consistently working to make sure that states like Rhode Island that have led the way in children’s health coverage are rewarded for their leadership. For example, he worked to ensure that our state received CHIP funds that other states had left on the table.
We are so close to finishing the job for kids, in Rhode Island and in the U.S., thanks in large part to Medicaid and CHIP. In 2008, 9.9 percent of U.S. children were uninsured, the lowest rate since 1987. As national health reform takes shape, we need to build on the success of CHIP. Affordable, high-quality health insurance coverage for all children is a clear priority.
Children have unique developmental and health needs that need to be addressed; they are not “little adults.” Health coverage for children requires the same developmental approach that currently exists in Medicaid and CHIP – covering children from head to toe, including attention to physical, mental and oral health, access to preventive, primary and specialty care, and affordable payments that let families actually use the health coverage they have. That has been our commitment in Rhode Island, and as a nation we must build on the successful systems that have been proven again and again to improve health outcomes for children and families.