The Current State of Children’s Healthcare: A Benchmark for Evaluating New Policies

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November 20, 2016; New York Times

During his campaign, President-elect Donald Trump deemed the Affordable Care Act a failure. He promised to use “free market principles…to create sound public policy that will broaden healthcare access, make healthcare more affordable, and improve the quality of the care available to all Americans.” With the backing of a Republican-controlled House and Senate, he will have a chance to put his vision into action.

A study released this week by the Children’s Health Fund provides an important benchmark for evaluating how replacing or modifying the ACA will address the ongoing challenge of getting medical care to children. Using data from the census, the NIH, and its own research, CHF’s study defines the starting point for this new round of reform.

More than 50 years after passage of Medicaid (the federal health insurance program designed to support health care for poor children and people with disabilities), almost two decades following passage of the Children’s Health Insurance Program, and six years after the introduction of the Affordable Care Act (Obamacare), approximately 28 percent of children in the U.S. still do not have full access to essential health services.

This translates into 20.3 million children who do not receive care that meets modern pediatric standards. Those standards are spelled out by the American Academy of Pediatrics (AAP), which recommends that all children should receive immunizations and other preventive services, be treated for acute and chronic medical conditions, and have access to mental health support and dental care. Round-the-clock availability of emergency services is also seen as a necessity, as is being able to receive care from family practitioners and skilled specialists as needed.

Despite three major federal initiatives designed to expand medical coverage, over 3 million children remain uninsured. For another 17 million, services are either not accessible or unaffordable.

Category Number of children % of all children
Uninsured 3.3 million 4.5%
Insured but missing timely well child checks (indicative of lack of access to primary care) 10.3 million 14%
Children on Medicaid/CHIP who have access to primary care but have unmet pediatric needs subspecialty care 6.7 million 9%
TOTAL 20.3 million 28%

The existing programs have lowered the number of uninsured children from more than 10 million in the 1990s. But cost still keeps care from children even when insurance is in place.

Employees’ contributions to the cost of the premiums climbed by 93 percent over that same period, though the rate of increase slowed after the passage of the Affordable Care Act in 2010. The average deductible for an individual with health insurance was 5 percent of median income in 2013, up from 2 percent in 2003.

The reports described how healthcare is compromised as parents struggle to fit it into their tight budgets:

Parents faced with financial barriers might seek to save money by calling their doctor for advice, rather than seeing that doctor in person; rather than fill expensive prescriptions, a parent might rely on a limited supply of pharmaceutical samples. The medical debt incurred by such costs has been linked to reduced access to care, creating a vicious cycle.

And finding caregivers who will accept Medicaid or CHIP patients can also be hard. One mother described her frustrating experience to the New York Times:

“When I was pregnant with my last child, I had such a hard time finding prenatal care,” she said. She called 15 to 20 doctors before finding one who took her insurance.

“I mean, we would call places and they would be like, ‘we take it’ but it turned out they didn’t.”

Even something as simple as getting medicine recently for her son’s strep throat was not simple. Because of a mix-up with her insurance card, she had to cover a $20 co-payment for a prescription that should have been free.

Many parts of the country simply lack the medical personnel to provide the needed care.

As the details of our nation’s new national healthcare direction emerge, how will this picture change? How will the 3 million currently uninsured children get proper coverage? Could new healthcare policy actually increase the number of uninsured children? What will draw new providers to locations that need them? Will all children eventually get the AAP’s recommended level of healthcare? These are the questions we should be asking policymakers and legislators as they advocate for their new market-based system.—Martin Levine