1990s The In the 1990s, the AAP pushed access to care, helped slash SIDS rates by Alyson Sulaski Wyckoff , Associate Editor Copyright © 2020 American Academy of Pediatrics Editor’s note: Th is is the eighth of a series of articles on the AAP’s 90th anniversary published by AAP News, (August, 2020). Events of the 1990s illustrate how the Academy, its chapters and others played a role in responding to a changing profession as they tackled issues such as access to care and new concerns in child health and health care fi nancing. Experts say the right people came together in a fast-changing environment. “A lot of changes occurred at the right time. It all kind of got tied together, and the AAP was right at the front end,” recalled Errol R. Alden, M.D., FAAP, former AAP CEO/ executive director. Access to care, medical home In 1990, about 15% of children had no health insurance. Th e AAP launched a multipronged eff ort to address the problem, releasing Children First, a plan for comprehensive insurance coverage of children and pregnant women as well as fair payment for pediatricians this marked what may have been the Academy’s fi rst legislative proposal. A year later, Rep. Robert Matsui (D-Calif.) introduced a bill based on the AAP proposal. Th e AAP followed with the Children: Our Future public education campaign on the need for comprehensive care. Although the health coverage measure failed, it raised awareness of the Academy’s No. 1 priority. Th e Matsui bill “started a conversation” on the concept of insuring all chil- dren, said Judy Dolins, former AAP chief implementation offi cer and senior vice president, Community and Chapter Aff airs and Quality Improvement. “… the nation wasn’t ready for it yet,” she said, “but the Academy was already pushing that forward.” Medicaid expansions also were increasing at this time. In the mid-’90s, the Academy helped chapters advocate for Medicaid through the Help Us Grow campaign. A major achievement was what now is the Children’s Health Insurance Program (CHIP). Federal matching funds were given to states to provide health coverage to children in families with incomes too high for Medicaid but who couldn’t aff ord private coverage. Th e Academy advised chapters and worked with the American Medical Association to educate state medical societies about CHIP. Th e AAP also created the Task Force on Minority Children’s Access to Pediatric Care chaired by Robert L. Johnson, M.D., FAAP. It issued 66 recommendations to address access and quality of care for minority children and minority representation within pediatricians’ ranks (https://bit.ly/2Z3IFfu). In his 1996 presidential address, Maurice E. Keenan, M.D., FAAP, commented on minority access and other issues, noting, “As president, my eyes have been opened to how much the Academy has done and all that still needs to be done.” Th e Vaccines for Children (VFC) program paved the way for low-income children’s no-cost access to vaccines—and in a pediatrician’s offi ce (https://bit.ly/3gAuIv9). An AAP Periodic Survey had found that about half of pediatricians were referring some patient families out of their offi ce to obtain vaccines mostly because of inability to pay. Immunizations were a key part of well visits and preventive care—integral to the medical home and pediatricians’ role as primary care providers. uni24F2
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