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tv   CMS Administrator Doctors Discuss Childrens Health  CSPAN  November 19, 2021 8:27am-9:05am EST

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>> ahead of the centers for medicare and medicaid services and several pediatric doctors talked about current children's healthcare challenges. the "washington te 35 minute event. >> guttmacher on jonathan capehart. welcome to "washington post live",os and the first part of a two-part series about children's health equity starting off with the conversation the administrator of the centers for medicare and medicaid services chiquita brooks-lasure. administrator brooks-lasure welcome to "washington post live." >> thank you so much for having me and thank you for tackling this so important issue. >> of course. thank you again. beforere we get to children's health equity let's talk about the lawsuit filed this week by ten states seeking to block the administration's covid vaccine mandate. the suit claims the issued last
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week threatens with job loss means of healthcare workers who risk their lives in the early days of the covid-19 pandemic to care for strangers and friends in their community. your response toom that asserti. w we came to the conclusion for us to decide that it was critical to acquire a vaccine requirement for the facilities over which we have responsibility which includes medicare and medicaid certified facilities. the virus is leading to people not being able to go to work whether because they are sick or they are quarantining. when we were looking at where in the country we are seeing covid-19 outbreaks and
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hospitalizations, we wanted to make sure people are safe and we know how much health-care workers know about making sure that patients are safe. that has been our perspective. we want to work with facilities for this to be a voluntary and collaborative process to get people vaccinated with exceptions if they have medical conditions. our focus is on making sure that people are safe. as we shift to thinking about child coverage, how wonderful is this? as a mother, i am so thrilled that kids five to 11 can get vaccinated. it is so incredible that our vaccines were available so fast thanks to the hard work of so many people and we are now in a
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position where we can hopefully be getting out of this pandemic soon. jonathan: i want to go back to something you said about working with facilities. that is something you said in an interview with a colleague of mine earlier this week. what do you mean by that? how does working with -- what does working with these facilities look like? chiquita: the relationship we have at cms with facilities we are responsible for is collaborative. this is work we do every day. we survey facilities and help them meet their requirements of which there are many. this is another one where we will work with facilities to develop a plan. what we are focused on is facilities taking those actions to determine how to get their
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workers, nurses, doctors vaccinated. a lot of this is around education. a lot of this is around peers talking to each other about the benefits. that is what we have seen in terms of vaccine hesitancy that a lot of this is about education. that is part of what i mean when i talk about working with facilities to make sure people feel they are hearing from people they trust. a lot of these workers, you think of the range of who we are talking about. we are talking about the home care workers that go into children -- go into people's homes to care for them. maybe younger women, a lot of the workers are of modest means. we know a lot of the hesitancy is hesitancy and that is why we are prioritizing education and not wanting to this -- not
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wanting this to be a draconian action. it is about making sure people really understand all of the issues that are taking place. jonathan: last question on this, are using much resistance to this mandate? it makes sense to have a mandate , but are you seeing as a result large-scale resistance on the part of those for now have to get the vaccine? chiquita: what we have seen and what informs our decision-making is that in the states and facilities that already have mandates, we have seen a huge jump in the number of people who get vaccinated. trinity, which is one of the largest catholic systems in the
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country, went from 75% to over 95% when they instituted a requirement. even though there is a lot of discussion about people being concerned, when you look at the data, the number of people who have chosen to leave has been really small compared to the people who have taken that second step. sometimes you just need that extra push. jonathan: let's talk about children's health equity. give us a primer about how medicaid is helping promote health equity among children. chiquita: health insurance coverage is key to making sure health equity disparities are addressed. it is difficult to get the
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health care you need if you do not have the confidence and assurance that when you go to the doctor or need a prescription, that will be cared for. the medicaid program and chip program have been month -- have been instrumental. i started my career in the federal government after the chip program became the law of the land. just seeing changes in people's lives by being able to enroll their children in coverage, we have seen what difference that makes. in 2021, we have record enrollment in medicaid, chip, and aca coverage. one of the things that is key is that kids have comprehensive coverage in medicaid and chip.
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a lot of times kids don't enroll and less of their parents are enrolled. with the coverage, we over the last 10 years have seen strong coverage in those programs. jonathan: medicaid and chip account for about 35% of insurance provided to children in the u.s.. what are the limitations around medicaid and chip can provide to pediatric patients? chiquita: i would say that the coverage is comprehensive. in the medicaid program, we have eps which covers so many services in terms of anything that is diagnosed needs to be covered under the medicaid program. in chip, we have a well-baby, well-child.
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a number of critical services are covered. i think we have to continue to make sure people not just have the coverage, but have access to the providers they need and continue to have access. some of that is education, some of that is making sure people know what is available to them. that is sometimes where we see disparities in terms of whether it is access or not fully knowing what is available. that is something we are incredibly focused on. jonathan: you came into your position under a new administration during the period -- during the pandemic. it was may of this year. how has the pandemic eliminated the issues for children that exist in the health care system?
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chiquita: we are at such a critical moment in health care policy. over the asked year and a half, eyes have been opened to these disparities. it shows an opportunity where we see what this means is a country , these gaps in the health care system and what it means in our lives and our health as a nation. i look at this time which is a difficult one as an opportunity to do thinks differently. again, to make sure we are very focused on the underserved in this administration, making sure every community is hearing what is available to them. there has been acute attention to maternal health. i think we all understand that the health of a mother before
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she gives birth has an effect on the health of the child. the biden-harris administration has been focused on expanding postpartum coverage. we have seen that with the american rescue plan, giving states the option to expand coverage for 12 months. that is a real area of focus. i did a lot of research on that before i came to this position. we see maternal health outcomes even two months after women have given birth. we have seen morbidity where women are not living their healthiest lives. making sure we have health insurance coverage, making sure women are getting the help they need so they can care for their children, making sure they are going to the doctor. we have an incredible opportunity to move the needle
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on what are appalling numbers in our country on mortality. jonathan: it just occurred to me, what about those states that have not expanded medicaid coverage under the affordable care act? how has that played into these health equity disparities we are seeing around the country? >> it is a critical issue. we, as the administration, continue to encourage states to take up the medicaid expansion, the american rescue plan, put more dollars for the states to expand. if you think about what happens in these that have not expanded coverage, some of the poorest people in our country not having access to critical services puts a strain on our hospitals and on our providers. it makes a difference when it comes to child health.
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if people don't have coverage and then get pregnant and then have coverage, you have already let them be farther back. if you don't get treatment for underlying services until you have coverage, your health is not as strong as it could be. the coverage gap, as we call it, is a crucial aspect. necessary, not efficient to making sure we address health disparities and improve child health. jonathan: i have to talk about the social determinants of health. what services need to be provided to medicaid pediatric recipients to bolster their coverage and make it as equitable as possible? chiquita: there is a lot of focus on the social determinants of health and i like to think of
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it as those services that are adjacent to health that influenced your ability -- that influenced your ability -- that influence your ability to get coverage. these are things like safe housing and if you have asthma and your home has mold in it, understanding these essential issues, access to essential foods. it is part of the program that medicaid can -- expanding benefits. part of this is really making sure public health part of our health care system is integrated with the programs that cms administers, medicaid and chip,
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medicare and marketplace coverage. jonathan: what, if any, work is being done to close the service deserts among physicians that do not accept medicaid? chiquita: it is a critical issue. providers across the country have options about what types of coverage -- what types of programs they choose to participate in. this fits into the access issue of making sure program -- make a short medicaid is attracting the providers we need to make sure people have adequate care. it is something we have some responsibility for but states are our partners in this in terms of payment rates and thinking about how to make sure the program is easy for
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providers to precipitate in and encouraging providers to participate in this program so children and everyone else on the program can actually see their doctor and not have the card in your pocket -- and not just have the card in your pocket, but make sure you see your provider. jonathan: i have to ask this truly last question, those states that have not expanded medicaid under the affordable care act, is there any way around them? if not to go around them, to compel them to provide access to health care to the people in their state? chiquita: we strongly encourage states to come in and we continue to have conversations with them because we believe states can design their programs in way that makes sense.
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the president has been supportive of congress filling the congress -- the coverage gap. four states that have not expanded medicaid for allowing them to get coverage to the federal government, that is something that is in the build back better agenda. we hope congress -- they are in their process. that would be one way if states choose not to expand, they would get coverage. jonathan: you know, you can only strongly encourage. i was being a little provocative with that question. administrative of the centers for medicare and medicaid services, chiquita brooks-lasure , we are out of time.
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jonathan: welcome back to "the washington post live." i am joined by a professor of pediatrics at harvard medical school and a vaccine expert at the bloomberg school of public health at johns hopkins university. thank you both very much for coming. >> thank you very much. jonathan: let's start with well-child visits. how do they impact future health? especially for children who don't -- would not have access to sufficient health services as an infant? >> well-child visits are part of working to make sure that children grow up healthy, giving them and their parents his skills and abilities for health
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care up. -- especially kids in poverty. there is a lot of work we can do in prevention in that area, too. jonathan: i have a question about that point but i will have to hold off. many visits include vaccinations which have been front and center throughout the pandemic. explain how vaccines layer the -- vaccines level the playing field? >> vaccines are a low -- you will need a vaccine once or twice in your life to prevent a disease from happening ever. if you can prevent a disease from happening, you never have to treat it.
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you never have to deal with the -- of the disease. if you can vaccinate everybody, they will never have to deal with measles or with rotavirus. for covid, especially, vaccines can prevent hospitalizations and severe disease. if you can prevent that, it will take away the burden of having to seek health care for people who have less access. jonathan: how big of an issue is access to vaccines? what needs to be done for vaccines to be more readily available for children across the country? dr. talaat: access to vaccines is important because we know not everybody has the same access to health care. not everyone has a pediatrician they can go to.
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people are more likely to enroll their children in chip if they have health insurance. we need to make sure vaccines are available in as many places as children are pleasant. -- children are present. it would be great to have vaccines in schools. jonathan: i am wondering how much vaccine hesitancy contributes to larger inequities among children. dr. talaat: for the most part, vaccine hesitancy does not seem to be a huge role in pediatric vaccines with the exception of a couple of the vaccines that people are hesitant about. most of the kids who are unvaccinated, it has a lot more to do with access.
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we are seeing rising rates of the facts and hesitancy in the u.s. for pediatric vaccines and that is something to watch carefully. dr. perrin: we have a ton of information about vaccines and how effective they are, as my colleague said. the evidence is very strong about determine this value of the vaccines. on the other hand, there are many people who have raised questions about health care protections in general and are worried about them. poorer families of color have a history of bad experiences in the hands of health care professionals. some don't believe what they're getting is the right thing. i believe that does play a role in hesitancy. jonathan: let me stick with you on vaccines and talk about the
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politicization of the vaccines. we are seeing it around coronavirus. are you concerned that kind of politicization will impact children's vaccines? dr. perrin: absolutely. i think this is a dangerous factor of how we are treating a medical opportunity in crisis. the fact that we have politicized vaccines has prevented too many people from getting safe and effective treatments. we know people have died as a result of this politicization. jonathan: dr. talaat, i can see you have been nodding. your thoughts? dr. talaat: it is a frightening time as we see more politicization. for example, with the covid
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vaccines, they are incredibly effective and effective at saving lives. what we are seeing are more and more places where vaccine rates are low. we see more of the deaths happening in those areas. in the places where vaccination rates are higher, there are fewer deaths. it is important to not politicized vaccines, not politicize public health so we can reach out to as many people as possible and people feel comfortable talking to health care providers. jonathan: i want to remind everyone, dr. perrin that you are the former director of the american academy of pediatrics. have we seen this before or is this brand-new? how concerned are you that we are moving into an area where we
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will not be able to pull ourselves out of? dr. perrin: let me correct you, i'm the former president of the american academy of pediatrics. i would never say i directed it, that is a very big job. i do think this is not new. we have had this before. we have been seeing this for measles, for example, and the work in california that a pediatrician in the state senate has led efforts to get california kids vaccinated against measles. this is not new. there has been vaccine hesitancy throughout many decades. i think it is made worse now through the opportunities in social media to gather support for hesitancy and anti-vaccine activity. this is not new. it is incredibly important.
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i have seen measles in american children. i have seen the negative long-term results of measles. i saw people in iron lungs through polio. these are not minor issues, these are incredibly important issues for the health of our population. jonathan: dr. talaat, how do you get communities to overcome their hesitancy, to overcome their resistance and get them to take the vaccine no matter what the vaccine is for? how do you get over that? dr. talaat: i think you start by listening. listening to people and truly understanding what their head -- what their concerns are and meeting them where they are. tell them about your experiences, what you have seen.
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it is important to have trusted messengers in the community, people that parents and others can go to to ask questions, people they believe and they trust. that can be a pediatrician, the pastor of their church, it could be their barber or hairdresser. there are all sorts of creative ways to decrease vaccine hesitancy and to encourage people to get whatever the vaccine is. the first and most important thing is to listen to people's concerns. jonathan: let's get into the social determinants. the cdc research shows the more traumatic events a person suffers in childhood, physical, sexual, emotional abuse, domestic violence, you name it. the more likely that person is
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to suffer from chronic health issues later in life. talk about how a children's mental health affect their future health outcome. dr. perrin: that is a super question. we know so much about the incredibly -- about the incredible importance of the first four or five years of life. it is unbelievably -- unbelievable what we know about the development of the human brain this time. we know negative expenses affect how the brain works and will affect how the person's brain works throughout their life. it is important to deal with these negative events early on. we know that in the united states over the last decade, we have had rising death rates among people of working age in this country. those rising death rates don't just happen in 45 and
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50-year-olds. it starts and 25-year-olds. i know those rising death rates reflect in part some of these early negative experiences. there is a lot we know about what is causing these bad outcomes. we know more and more about what we can do to prevent those bad outcomes. jonathan: i'm going to turn this question to both of you. if we conquered poverty, this would solve a lot of problems. is that the only way to level the playing field when it comes to equity in health care for children? dr. perrin, you go first. dr. perrin: dealing with child poverty is unbelievably important. the american academy of pediatrics has been clear about the importance of addressing actively prevention and getting
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rid of child poverty. the child tax credit, which has been part of the administration's activities, is an important step forward in addressing child poverty. as pediatricians, we strongly support that kind of effort to improve the well-being of america's young families. there are other aspects of improving equity that we can do within the health care arena. we talked about medicaid already today, a phenomenally important program that has done such great things for america's kids. medicaid tends to treat its recipients, mainly because of how it pays its bills. it is not the birth -- it is not worth the same for people in america. an average across the u.s., the payment rates for medicaid are
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about two thirds that of the payment rates even for medicare. what we are saying in public policy is that we think these people are worth about three fourths of the people not covered by medicaid but covered by other programs including medicare. jonathan: dr. talaat, your view on that? dr. talaat: i agree that eliminating poverty would make a huge difference. also, just making sure everybody has the same access to health care. for example, there are places in our country that are vaccine deserts where you cannot go 15 minutes to get your vaccine. making sure everybody, including in rural areas and urban areas has the same access to health
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care. jonathan: we actually have any audience question for you, dr. talaat. how can we best get kids engaged with their own health care earlier? dr. talaat: it is important to talk to them when they go to the pediatrician about why they go to the pediatrician. talk to them about smarter choices and healthy choices. >> if we have chronic diseases, my daughter has asthma, get them involved in managing their health care and taking-- and being responsible for their medications as soon as they're able to do that. and thinking that would go a long way to getting them involved in their own health care and also, to talk to them
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about the health problems that occur in the united states and elsewhere and make them aware of the bigger picture as well and what their role is in that picture. >> all right, i'm going to throw out one more question, it's a leading question, but i think it's a good question to end on. ill -- i'll start with you, dr. perrin, how important are vaccine mandates? so vaccine mandates are one of the reasons that the united states has some of the highest rates of vaccine coverage for children who are in school at school age. we have less good coverage rates for children age two than many of the european countries have because they have vaccine mandates there for younger children. the evidence is overwhelmingly clear that vaccine mandates do lead to much higher rates of
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vaccination and it's a public health venture. it's something which basically says that vaccines are incredibly important for the health of the united states public. >> doctor? >> i completely agree with dr. perrin. what we found is in states where mandates are tighter to go to school, where there are fewer exemptions shall the rates are higher. it's a good tool to make sure that all kids are vaccinated. >> and the vaccine expert at john hopkins university and dr. james perrin, professor of pediatrics at harvard medical school and former president, not director, former president of the american academy of pediatrics, thank you both very very much for coming to washington post live. have a great weekend. >> you, too, great talking to you. >> like wise. and thank you as always for
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