View Research by Author - Christine Coyer

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Maximizing health insurance coverage for children under the ACA will require addressing the complex scenarios that prevent some children from obtaining or retaining coverage. These scenarios include situations where children are eligible for Medicaid or CHIP but their parents are not, as well as those where children are living without at least one of their parents. We provide national estimates of the number of children in these complex coverage scenarios and find that children facing at least one complex scenario are more likely to be uninsured than other children. In addition to national estimates, we present state-level estimates for California, New York, and Texas.

Federal spending on children's health increased greatly over the past 50 years, although it remained a modest 10 percent of total health spending in 2010. The largest program in the children's health budget, Medicaid, accounted for $74 billion and 85 percent of all federal spending on children's health in 2010. The Affordable Care Act (ACA) included provisions that will increase health insurance coverage for both children and their parents. However, the magnitude of the estimated impact of the ACA on children's coverage depends heavily on the continuation of current Medicaid and CHIP coverage for children.

Asthma is one of the most common chronic conditions among children in the United States, affecting nearly 10 percent of children in 2008. Medicaid and CHIP are covering a growing number of asthmatic children; by 2008, two-thirds of low-income asthmatic children were covered by Medicaid/CHIP. Our findings suggest that over the last decade, there has been a trend towards improvement in asthma-related outcomes and receipt of parental asthma management training for asthmatic children with Medicaid/CHIP coverage. Further expansions in health insurance coverage could lead to reductions in negative asthma outcomes and their associated costs, but other changes to the service delivery system would be needed as well.

In 2008 San Mateo County, California launched its Adult Coverage Expansion and Systems Redesign Initiative. The initiative expanded coverage for all uninsured adults below 200 percent of the poverty level and redesigned care in county safety net clinics. The program substantially improved access to care for uninsured adults, as well as improved continuity and quality of care for those served by county safety net clinics. However, access remains a problem for new enrollees, due to restrained provider supply and the economic recession. The report provides lessons for other counties as they expand coverage under national health reform.

This latest edition of our annual chartbook series for New York State features detailed information about differences in insurance coverage and uninsurance around New York State and within New York City. Overall, 12.9 percent of New Yorkers (889,000 total) under the age of 65 lacked health insurance in 2009, unchanged from the previous year despite an ongoing recession. Data for 14 separate regions across New York State, including the five boroughs of New York City and for 55 separate neighborhoods within the city itself show enormous variation in health insurance coverage across the state.

This report provides detailed demographic information on Virginia's uninsured population in 2009, including data on their income, employment status, race, ethnicity, age and citizenship, and region of residence. Between 2008 and 2009, 47,000 nonelderly adults in Virginia became newly uninsured, though there was no significant change in the number of uninsured children, due in part to increased coverage through Medicaid and CHIP. Overall, 13.2 percent of Virginians (889,000 total) under the age of 65 lacked health insurance in 2009. The majority of Virginia's uninsured are US citizens and live in working families, but most are in low-income families.

The number of children eligible for and enrolled in Medicaid and CHIP increased in recent years. As a consequence, the number of eligible but uninsured kids fell by about 340,000 between 2008 and 2009. Rates of participation in Medicaid/CHIP increased, from 82.1 to 84.8 percent nationally, with sixteen states achieving participation rates of 90 percent or higher in 2009. This report suggests that the high participation rates among children over the past few years are likely due in part to ongoing federal and state policy efforts aimed at improving enrollment and retention among children.

Maximizing insurance coverage for children under the Affordable Care Act will require considering how the new system and its rules will apply to children facing complex coverage scenarios. The purpose of this brief is to explore several scenarios in which children may face particular challenges in accessing health insurance coverage. We find that roughly 20 million children live in situations that create particular challenges in accessing insurance coverage due to within-family variation in eligibility for different types of coverage and that nearly 28 million children live apart from at least one of their parents, creating additional complexities in accessing coverage.

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