December 4th, 2013
Working with state and national advocacy organizations as well as the National Academy for State Health Policy (NASHP), several national foundations are aiming to shape the answer to this question. While most eyes are focused on the prize of coverage for adults, the David and Lucile Packard Foundation and The Atlantic Philanthropies are continuing their efforts to make sure that all children have health insurance coverage.
Today, that means making sure that attention to children’s coverage does not get lost as the Affordable Care Act (ACA) is implemented and that the ACA will work well for children and families.
Public and private efforts at both the national and state levels to boost rates of health insurance coverage among children and youth have been a resounding success. According to the US Census Bureau, in 1999 more than one in five (22 percent) low-income children were uninsured; by 2012, fewer than one in six (13 percent) were uninsured. Among all children, only 9 percent remained uninsured. Children’s insurance coverage increased, even as employer coverage eroded and the country experienced a deep recession. Medicaid and its little (but innovative) sister, the Children’s Health Insurance Program (CHIP), along with their partners, can take much credit.
But 4 million children eligible for Medicaid and CHIP were still uninsured in 2011. The ACA, in extending CHIP coverage to 2015, in incorporating many of CHIP’s enrollment and renewal innovations, and in extending coverage to parents, promises further progress in getting these children insured. Estimates are that with implementation of the ACA, the uninsured rates for children of all races and ethnicities (including undocumented children) could be nearly halved, and the rate for low-income children could be reduced by nearly two-thirds, to 4 percent.
However, getting to the finish line, to borrow the concept used by the Packard Foundation, will require continued focus and creative problem solving on the part of policy makers and partners, including foundations. In addition to some large questions and concerns, a number of thorny and more specific policy and practice issues have arisen in ACA implementation as it affects children.