Letter from Pat Tiberi's Office

A while back I posted the text of a message I had fired off to Rep. Tiberi concerning a bill that he had introduced mandating insurers to cover reconstructive surgery for children.

I was working from a press release by an interest group, so I didn't want to make too many assumptions about the actual bill. The intent of the legislation seemed to be a good one, but from the sound of it the bill was not at all conservative in the way that it imposed government onto business practices, and not at all progressive in that it would possibly only benefit kids who already had private health insurance, and/or add even more costs to Medicaid, one of the entitlement programs whose budget sizes have become Mr. Tiberi's pet issue. So even though (perhaps especially because) I have no reason to believe that anything but a sincere desire to help kids motivated Mr. Tiberi, I was surprised at the form of the proposed solution and hoped to get some clarification.

In the past, I have never recieved anything but auto-replies from D.C., so I have to admit that I was surprised when I got an email back addressing each of my questions. I was also more surprised than I probably should have been to see that the tone was really quite polite. There has been a disorienting outbreak of civility lately amongst the local Republicans I follow. Civility may not make for the most riveting blog exchanges, but it is certainly a very welcome development. So for the time being, in which I've explained myself and my point of view, I think it's only fair to let Mr. Tiberi have a chance to speak for himself:

Dear (bonobo),



Thank you so much for your very kind email concerning my original cosponsorship of the Children's Access to Reconstructive Evaluation & Surgery (CARES) Act of 2007. This is indeed an interesting piece of legislation and I appreciate your encouragement and interest in this issue. Please accept my apologies for the delay in responding. Due to the large volume of mail I receive I am not always able to respond as quickly as I would like.



This legislation will help to provide necessary reconstructive surgical care for congenital deformities including cleft lip, cleft palate, skin lesions, vascular anomalies, malformations of the ear, hand, or foot, and other more profound craniofacial deformities. It is particularly important for children with these congenital conditions in helping them to achieve a sense of normalcy and function. I hope this is an issue that can be addressed by Congress. I also find it very interesting and encouraging that President Bush signed comparable legislation into state law while he was Governor of Texas.



In your email, you asked several questions concerning Medicaid, mental health, and the uninsured. Allow me to address the Medicaid and uninsured questions first.



As I'm sure you know, Medicaid is a joint state and federal benefit. States generally have wide discretion over payment methodologies. I understand that in the more recent past there has been a trend of moving Medicaid benefits into managed care plans and away from fee-for-service payments. The general basis for reimbursement, at least as I understand administration of benefits in Ohio, is that processes and procedures must be deemed "medically necessary and reasonable" in order to qualify for coverage. After speaking with several health care professionals in central Ohio, it is my understanding that the determination of medical necessity for children covered by Medicaid is made by the child's physician.



With regard to children who are not covered by private insurance and do not qualify for Medicaid, access to health care is admittedly more challenging. Right now, millions of Americans have no health insurance and millions more are underinsured. As you know, employer-provided health care benefits are the major source of health insurance for workers and their families. However, the spiraling cost of health care has made it increasingly difficult for businesses, particularly small businesses, to provide health insurance for their employees.



A number of different reform proposals have been discussed in Congress and, in some cases, have been approved repeatedly in the U.S. House of Representatives in recent years. These include initiatives to increase the availability of health insurance through new groups called association health plans (which will give small businesses the ability to join together to purchase insurance for their employees with the same advantages that large companies enjoy), and provide tax advantaged health savings accounts. However, there is much more work to be done.



My constituents in central Ohio are fortunate to have access to Columbus Children's Hospital. Columbus Children's is dedicated to providing medically necessary care for all of our children, regardless of their insurance status or ability to pay. Again, it is my understanding that medical necessity is determined by the child's physician.



You are correct that this is similar to the concept of mental health parity legislation. In fact, several bills have been introduced in Congress this year that address this issue, each in a slightly different way. Additionally, the Health Subcommittee of the House Ways and Means Committee has held a hearing on these proposals, and additional hearings are anticipated. While I'm not a member of this subcommittee, I have followed this issue with great interest. I expect that a consensus mental health parity bill will emerge at some point this year, and I look forward to supporting a responsible solution to this issue.



Thank you again for your email. Please feel free to contact my office if I may be of assistance in the future or if you would like to discuss any of these issues further.




Sincerely,



Patrick J. Tiberi



Representative to Congress