Children's medical coverage is a private-public patchwork. However, according to the Kaiser Family Foundation, more than 8 million children, or 10.4 percent, under age 19 lacked health insurance in 2008. Uninsured children have lower immunization rates, more emergency room visits and higher uncontrolled asthma attacks than children with medical coverage. The 2009 Children's Health Insurance Program, or CHIP, expansions and many provisions of the 2010 Patient Protection and Affordable Care Act, or ACA, target medical coverage of children.
Children's Medical Coverage
According to the Kaiser Family Foundation, nearly 60 percent of children are insured through their parents, primarily via employer-sponsored coverage. Just over 30 percent are insured through public programs, largely Medicaid and CHIP, but some are covered through the Department of Defense or Veterans Administration programs. The proportion of children having coverage through the public sector fluctuates with the economy when parents lose their jobs or employers raise premiums, making coverage unaffordable, or drop coverage altogether.
Uninsured Children
According to the Kaiser Family Foundation, more than two-thirds of uninsured children are in families with at least one full time worker. They may lack insurance because their parents are self-employed and coverage is too expensive or work for small employers who do not offer insurance. These are primarily children of the working poor. Seventy-two percent are in families with incomes less than 200 percent of the federal poverty level, or FPL. The FPL was $22,025 for a family of four in 2008, according to the U.S. Census Bureau. Being uninsured varies by state: in Connecticut the percent of uninsured children is just over 6 percent while in Texas it is 20.1 percent. Some uninsured children would qualify for Medicaid or CHIP but their parents have not enrolled them.
Health Consequences
The Children's Defense Fund, the Kaiser Family Foundation and other organizations have long documented that children without medical coverage go the doctor one-fifth as often as covered children and are 10 times more likely to have untreated asthma, diabetes or obesity. Children without coverage also do less well in school. Disproportionately, minority children lack medical coverage.
CHIP Expansion
In 2009, CHIP was reauthorized and strengthened, permitting states greater flexibility to expand coverage to low-income children. This joint state-federal program covers about 7 million children. Forty-seven states and the District of Columbia have eligibility at 200 percent of the FPL.
Health Reform
According to the Children's Defense Fund, the ACA strengthens the coverage for children as follows:
-- Maintains CHIP until 2019 until development of "health insurance exchanges," which will expand coverage to 14 million.
-- Increases the Medicaid reimbursement rate, encouraging providers to accept more Medicaid patients.
-- Expands Medicaid, requiring parents to insure their children before they can be covered.
-- Provides tax credits to higher income families to facilitate coverage.
-- Enables children to remain covered if their parents switch or lose their jobs.
-- Permits parents to provide coverage until their children are age 26.
-- Promotes preventive care by eliminating co-payments for "Bright Futures" services, defined as American Academy of Pediatrics well-child care services.
-- Increases funding for School Based Health Centers.
-- Provides Medicaid coverage for children aging out of foster care until age 26.
References
- Kaiser Family Foundation: Health Coverage of Children: The Role of Medicaid and CHIP
- Children's Defense Fund: What Does It Mean for Children?
- Robert Woods Johnson Foundation: Going Without: America's Uninsured Children
- Kaiser Family Foundation: Health Insurance Coverage of Children 0-18, States (2007-2008), U.S. (2008)
- Children's Defense Fund: Uninsured Children: Policy Priorities
