Calculating the impact of changes to children’s coverage

Published on
June 27, 2017

In Washington, children’s needs are often an afterthought. After all, they are not a particularly powerful constituency.

Take the funding for the bipartisan Children’s Health Insurance Program (CHIP), which will expire on Sept. 30. Congress didn’t hold the first hearing on the issue – therefore taking the very first step in the legislative process – until a little more than three months before that deadline. It’s unclear when a bill will be written to extend the funding.

Lawmakers have been preoccupied with considering ways to reduce the spending growth of Medicaid, which pays for about half of all births in the United States. House lawmakers voted and Senate Republican leaders wrote a bill without holding a single hearing on the impact of those actions.

Despite the recent lack of focus on children’s health care coverage, the United States has seen progress on this issue in recent decades.

Children’s coverage recently reached a record high with 95 percent of America’s youth covered, up from 91 percent in 2008 and about 88 percent in 2000. In just two years when the health care law was being implemented, the uninsured rate for children fell by 2.3 percentage points from 7.1 percent in 2013 to 4.8 percent in 2015. During that time, almost two million children gained coverage.

But consumer advocates are concerned those gains won’t continue. Actions in Congress, states or the Department of Health and Human Services could put coverage at risk.

Even if changes in policies do not target children specifically, any policy that reduces the likelihood that parents will be covered also runs the possibility of leading to an erosion of coverage for low-income kids.

The Trump administration, governors and Congress all have influence over the coverage options for children and families. And coverage ultimately affects kids’ well-being.

This year, several important decisions loom that could have an outsized impact on families. Congress is weighing legislation that could scale back the federal financial commitment on Medicaid and a separate bill that could change the terms of CHIP. Governors are trying to plan their responses to these potential actions and make determinations of their own on how to shape these programs. Several states, for instance, are weighing whether to trim Medicaid budgets.

My goal is to connect the actions that are being considered in Washington and state capitals with the people who will benefit from or be harmed by those decisions. I hope to reach beyond the Beltway in exploring these issues.

Beyond these potential changes is another question about how policies are being implemented. State officials may be taking steps to deter people from signing up for coverage. In other cases, consumers may themselves avoid enrolling in coverage for a number of reasons, including affordability.

One group that may be increasingly wary of signing up for insurance, Medicaid or children’s coverage is immigrant families. Parents who are living in the country illegally may be nervous about getting government-funded health care coverage for their American-born children who are U.S. citizens because they may fear that it could reveal their immigration status and lead to deportation. Eighty-eight percent of children living with immigrant parents are U.S. citizens.

The problems with coverage vary significantly from state to state. The rates of people who do not have insurance or other coverage tend to be higher in the southern United States in states that did not expand Medicaid. I would like to talk to consumers, medical providers and elected officials in those areas about coverage and how it may be changing.

Some may question whether coverage actually makes a difference in individuals’ ability to receive medical treatment. A recent New England Journal of Medicine article by Harvard researchers Ben Sommers, Atul Gawande and Katherine Baicker synthesized the findings of research on this question. Their conclusion: “Insurance coverage increases access to care and improves a wide range of health outcomes. Arguing that health insurance coverage doesn’t improve health is simply inconsistent with the evidence.”