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House Proposal Could Put Spotlight On Asthma Care In Rural Missouri

Flickr: NIAID

Missouri is on the verge of breaking new ground in asthma care by extending more services to needy children in rural parts of the state. 

The additional services would include specialists to inspect more homes to pinpoint asthma triggers. They would also supply educators to show families and health providers how to identify and reduce the triggers, and to help asthmatic children manage their condition.

The program is part of a line item for the Department of Social Services in the Missouri House's budget bill. The item calls for spending $524.000 in state funds to get an additional $4.7 million in federal money for the new asthma services.

The Senate’s budget bill doesn’t include money for this program. Whether the house line item survives will depend on upcoming House-Senate negotiations on budget issues.  Supporters are hopeful that state lawmakers will make Missouri one of a few states investing additional state and federal Medicaid dollars to address asthma among all poor children.

In theory, needy children in urban areas, such as St. Louis and Kansas City, already have access to asthma care through Medicaid managed care programs. The new funding would allow Medicaid to reimburse providers for asthma education and home assessments in rural areas that are not part of Medicaid managed care. 

Coping with asthma

About 11 percent of children in the state are said to have asthma, a chronic disease that causes the airways to become inflamed, making breathing difficult. Between lacking resources and not following recommendations for controlling asthma in their children, many parents to resort to emergency room visits for short term relief. 

The prime supporter of the house' proposal for the asthma program is Rep. Sue Allen, R-Town and Country.

“This will have a bigger impact in rural areas, because the residents don’t have the great resources, the hospitals, such as Cardinal Glennon and Children’s, that we have,” she said.

Credit Missouri House of Representatives
Rep. Sue Allen is one of the biggest supporters of reforming Medicaid to expand services for asthma care.

“We don’t need to expand Medicaid. But I believe that we need to reform Medicaid and do better for those who truly need Medicaid services,” Allen said.

Among groups backing the effort is the St. Louis chapter of the Asthma and Allergy Foundation.  Its executive director, Joy Krieger, said the line item would help Missouri save money.

She said Medicaid allocates about $3,300 a year for health care for each child served in Missouri. But, she added, it is not uncommon for some needy kids to visit emergency rooms up to four times weekly for asthma.  Such frequent visits can result in added costs of between $17,000 to $19,000 a year to care for a single child with asthma, she said.

There are some things people can do to cut down on ER visits, Krieger said. She recommended cutting back factors that cause condition to flare up, such as dust mites in bedding; dog and cat dandruff; cock roach infestations; smoking and mice droppings, Krieger said. The plan in the house bill would require asthma educators to show parents how to address these environmental conditions. Examples include keeping pets out of the rooms of children, frequent washing  of bedding, and discouraging children from eating in their rooms, because they are likely to drop crumbs that invite rats and roaches. 

“We realize that the poorest of the poor, even though they live in the worst situations, are not aware that the home environment is making Johnny sick,” Krieger said. “That’s what this proposal is about.”

She said the program is similar to the medical model for caring for patients with diabetes.  “If you’ve been diagnosed with diabetes, a nurse educator is assigned to you. The nurse educator meets you, spends time with you at the hospital, and also at your home. We’re asking for that with an asthma educator. The funding would mean those two things would be reimbursed – the home assessment and the face-to-face asthma education visit.”

St. Louis: no longer an asthma capital

Although Missouri continues to have high rates of asthma, the St. Louis area should get credit for addressing some conditions that exacerbate the problem. In 2012, the city ranked 7th among the 100 “most challenging places to live with asthma,” according to the annual “Asthma Capital” ranking by the Asthma and Allergy Foundation of America.  Factors influencing a city’s ranking include ER visits; number of asthma specialists; poverty; access to asthma inhalers in schools; air quality; and smoke-free laws. 

St. Louis' improved Asthma Foundation ranking is due in part to the city’s 2009 smoking ban, which also is affecting ER visits, according to Pamela Walker, head of the city’s Health Department.

Credit St. Louis Health Department
Pamela Walker

In 2007, two years before the smoking ban, there were 2,903 ER visits by city residents who listed asthma as the main complaint, Walker said. Two years following the ban, there were 2,3225 such ER visits.

“This represents a statistically significant difference of 20 percent fewer visits in two years,” she said. 

Walker is pleased by the improvement, but she added that “we also know that there is still a lot of work to do.” She said, the city could use the same tactics to reduce childhood asthma as it did to reduce lead pointing: intense education, inspection and enforcement efforts over several years, it can do more to address child asthma.

Walker added that the state could help even more by expanding Medicaid and continuing to encourage people to enroll in insurance through the Affordable Care Act. That law gives patients more access to preventive care for chronic conditions such as asthma. 

The fight against the condition will continue to focus on environmental triggers, such as second-hand smoke, and educating parents and others about causes and consequences of asthma, Walker said. 

She praised the ongoing anti-asthma efforts by the city and St. Louis County, as well as collaborative efforts by the city, state and nonprofit groups, such as the Asthma Foundation. Such efforts, Walker said, could mean that the region “will see a continuous decline in ER visits and premature disability and death related to asthma.”

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.