Children with special health care needs: the canary in the health care reform coal mine.

An article entitled “Massachusetts Health Reform and Access for Children With Special Health Care Needs” by Smith and Chien appears in this month’s issue of Pediatrics. The investigators used parent-reported data from the 2005/2006 and 2009/2010 National Survey of Children With Special Health Care Needs to compare findings in Massachusetts before and after the implementation of health care reform. In addition, they compared these findings over the same time period with similar data from other states. Because children with special health care needs (CSHCN) are the most vulnerable to problems in the implementation of health care reform, assessing this population provides a window into how well a state is implementing the Affordable Care Act (ACA). Therefore, CSHCN are the proverbial “canary” in the health care reform “coal mine.” In 2006, Massachusetts passed health care reforms that were subsequently included in the national ACA. However, it is unclear whether the Massachusetts health care reform experience will be replicated in other states. Before its reforms were implemented in 2006, Massachusetts already had a very generous Medicaid program with children’s coverage to 200% of the federal poverty level. Unlike most states, an extensive pediatric primary, subspecialty, and specialty network capacity already existed and reasonable Medicaid payments supported participation and promoted access to primary and specialty care. In addition, Massachusetts health care reforms had broad bipartisan political as well as community support.