Although the final outcome of federal Medicaid restructuring is not yet known, less money and more state control are two sure bets. Combined federal and state funding reductions are estimated to be as high as 40 percent over the next seven years. State decisions to allocate shrinking resources will be hard-fought. Since the interests of nursing homes, the disabled and other Medicaid beneficiaries will be vocal, AAP chapters must be prepared to represent the 18 million children insured by the program. The Academy also must protect Medicaid reimbursement which supports the delivery of care by pediatricians, children's hospitals, community health centers and others.
Dr. Smith's column was intended to make AAP Fellows aware that their anxieties over "corporate medicine" are recognized by their organization. As a businessman, Dr. James tries to respond to the concerns of his constumers and, in that regard, the AAP is no different from Health-America. However, it would be incorrect for Dr. James to construe from the "Insight" column that the only concern the AAP has with "for-profit medicine" is the competitive threat that it poses to solo and small group practice office-based pediatricians.