Dr. Joshua Plavin: Extend Health Care to our Most Vulnerable Neighbors

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Dr. Joshua Plavin: Extend Health Care to our Most Vulnerable Neighbors

March 29, 2021

This commentary is by Dr. Josh Plavin, a primary care Internal Medicine & Pediatrics physician, and the Chief Medical Officer at Blue Cross and Blue Shield of Vermont. He lives in Montpelier.

Most parents have a memory like this: your child wakes up crying in the middle of the night with a blazing fever, a croupy cough that sounds like they are going to stop breathing, those pink cheeks and bright eyes, and tiny hands grasping your shirt as you snuggle them close. If you have health insurance, you don’t hesitate to reach for the phone to call your doctor. Just hearing that provider’s calm voice on the other end of the phone telling you what to do to help your child makes your racing heart calm and your worried mind slow down.

Imagine that same scenario when you don’t have a doctor you can call, and taking your feverish, gasping child to the hospital brings questions that are not in your native language and the registration focuses first on whether you have the means to pay the bill, not the health of your child.

One story is of an immigrant mother of four children who has worked full time in Vermont alongside her husband for seven years. When her two children who were born in Vermont are sick, she can confidently take them to the doctor without fear—they are enrolled with Dr. Dynasaur, Vermont’s free or low-cost health coverage for families below 312% of the Federal Poverty Level. For her two children who were not born in Vermont, going to the doctor means risking questions about their immigration status, and bills that represent nearly a month’s pay for simply walking through the door of the emergency department. Their experience with debt collection agencies post-visit has bordered on harassment, and the unnegotiated prices for these medical services are outrageous, even compared to the high prices for Vermonters who have health insurance coverage.

Worrying that your child’s sickness could worsen without basic medical care is a dilemma that no mother should be forced to confront.   

This dichotomy within one family is a stark reminder of all the inequities these siblings will face their entire lives. Health care should not be withheld because a person had the luck to have been born on one or the other side of a political border. All of these people are living and working in our communities and contributing to our economy. Some of these people are those who tend the animals and grow the crops to feed our neighbors and our families. They keep farms viable, which preserve the rolling hayfields of Vermont’s idyllic landscape. We rely on their labor, and in turn, we need to ensure that pregnant women and children have adequate access to health care.  

Every pregnant mother who lives in Vermont should have prenatal care—which significantly lowers the risk of complications to the mother and can mean the difference between a healthy baby and one with lifelong health challenges. The moment that baby takes their first breath in Vermont, she is a citizen entitled to health care. But by waiting until birth to give her that care, we are missing an opportunity to ensure she has every advantage to thrive. All children need their immunizations and health and wellness check-ups to ensure that they grow up healthy in our communities. Our recent experiences with the COVID pandemic have instilled the importance of our collective health. This policy addresses basic decency and the Vermont value of taking care of our neighbors.

I encourage the Vermont Legislature to pass H.430, which would expand Dr. Dynasaur to undocumented pregnant women and children, and it should be made effective immediately—this year, not letting yet another year pass with children going unseen by a pediatric provider. This is not only a question of health equity for our most vulnerable neighbors, it is a humanitarian question: should a mother have to tell one child that they can go to the doctor when they are ill, but tell another child that they aren’t worthy of basic health care when they catch the same sickness? Vermont has had a long tradition of protecting the most vulnerable. Undocumented pregnant women and children deserve to be protected too.

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