Medicaid

First Focus, a children's advocacy group, this week in its Children's Budget 2008 reported that only one cent of each "new" dollar of federal spending (excluding defense) goes to kids. A lot of the report focused on education, so we asked them how does health spending add up. The answer: not so hot.

The overall share of federal, non-defense spending going to children's programs has dropped by 10 percent over the past five years. Real discretionary spending on children has declined by more than 6 percent since 2004, while at the same time all other non-defense discretionary spending has increased by more than 8 percent, the group reported.

Because so much of spending on children' health is through Medicaid, SCHIP, and other entitlements, not out of the discretionary budget, spending on health programs did grow from 2004–08. However, total spending on children's health amounts to less than 2 percent of the total federal budget, and less than 0.4 percent of the Gross Domestic Product.

Outside the mandatory programs, discretionary spending on children's health has declined in real terms. Discretionary spending is down 6.3 percent. As a share of total federal spending, children's health spending has lost ground. Children's health spending currently makes up 1.9 percent of all federal spending, while in 2004 its share was 1.97 percent, a 3.5 percent drop.

Forget pheromones. A new poll from the Kaiser Family Foundation found that seven percent of adults reported that in the past year they or someone in their household decided to get married in order to get health insurance from a spouse. (We don't even want to think about what their bridal gift registry looks like.)

The Kaiser poll had lots of somber news as health care costs are taking their toll on American families (including the middle class) during the economic downturn. Twenty-eight percent report that they or their families have had a serious problem paying for health care, behind paying for gas (44 percent) and about tied with getting a good-paying job or raise in pay (29 percent). Smaller shares report serious problems paying their rent or mortgage (19 percent), dealing with credit card or other personal debt (18 percent), paying for food (18 percent) or losing money in the stock market (16 percent). That 28 percent figure was true as well for middle class families, making between $30,000 and $75,000.

"Many people view health and the economy as separate issues, but the cost of health care is a significant pocketbook issue for many families and paying for health care has become a key dimension of the public's economic concerns," Kaiser Family Foundation President and CEO Drew Altman said.

Congress and the President are doing battle yet again about Medicaid , and NPR's Julie Rovner explained in a nice piece this week why we all should care. She illustrated a point we've made ourselves about why insurance matters: the uninsured place an additional burden on already over-taxed Emergency Departments, affecting the quality of care for all of us.

Specifically, the costs associated with uncompensated care for the uninsured and underinsured, and Medicaid underpayment cause many EDs to either close or drastically scale back the number of emergency beds. In fact, between 1993 and 2003, 425 emergency departments closed nationwide. Median ED waiting times for the insured and uninsured increased by 36% between 1997 and 2004.

Rovner drove this point home by recalling some particularly moving testimony Dr. Angela Gardner, Vice President of the American College of Emergency Physicians and an emergency doctor from Galveston, Texas, made before the House Oversight Committee last fall. If you missed Gardner's testimony, here's a must read excerpt:

I worked in the emergency department on Tuesday night, and on my arrival all 48 of my beds were full. We had 22 patients in the hallway. We had 14 patients in the waiting room. We had three ambulances unloading and two helicopters waiting to land. That is a normal day. ...