and Martha Heberlein
Ever since the Affordable Care Act passed, people have
been calling us to ask “What does the law mean for kids and their families?” To
my great dismay, we were completely unable to answer this question even though
we are, after all, the “Center for Children and Families.” The only thing we could accurately say
was that the Congressional Budget Office thinks that 30 million people will
gain coverage, and, yeah, “we’re pretty darn sure that some of them are gonna
Luckily, we’ve got great friends and partners and so now
have an answer! With generous
support from the Atlantic Philanthropies’ KidsWell project, we recently were
able to pair up with Genevieve Kenney and Matthew Buettgens at the Urban
Institute to take a first look at what health reform means for children. The results were released today in a
Health Affairs article, and we encourage you to take a look, especially if you
are in need of some good news.
We found that under full implementation of the ACA, an
estimated 3.2 million children can be expected to gain health care coverage,
cutting the number of uninsured children in the US by 40%. As a result, 95% of
all children will have coverage.
Not quite as impressive as our friends in Massachusetts, but some very
heartening news for those of us who are focused on making sure that our
nation’s children have health care coverage.
As importantly, the gains predicted for parents are even
greater, as we could see a decline of almost 50% in the number of uninsured
parents. After the ACA is implemented, an estimated 90% of parents will be
The good news would be spread across income groups —
uninsurance rates are expected to decline for children in all income groups,
with the steepest decline expected for children in families with income between
138 and 250 percent of poverty. In
general, the increase in coverage is due to greater take-up of Medicaid and
CHIP by those already eligible, as well as the new subsidized exchange coverage
and the impact of the requirement to secure coverage.
Among children of different races or ethnicities,
Hispanic children will see the largest gains in coverage. (Even so, it is estimated that they
will continue to be uninsured at substantially higher rates than other
children, a sharp reminder that we all need to work especially hard to make the
ACA work for Hispanic families).
But — and you probably knew there was going to be a
“but,” because we are not into simplistic analysis — these outcomes are far
from assured. They depend on states and the federal government making sure that
Medicaid and CHIP coverage of children remains strong and participation in the
programs is increased. If we allow these programs to be scaled back or fail to
fund them, the ACA won’t work for kids.
Of particular interest to those of us who follow these
issues closely is what happens if CHIP is not funded beyond 2015 or if the
stability protections are repealed.
Under these scenarios, the ACA could have the inadvertent effect of
actually making kids only somewhat better off or even, we hate to say it, worse
off. “Seriously?” you may
ask…”Worse off?” Unfortunately,
yes. For example, if the stability
protections are repealed, between 8 and 9.1 million children could find
themselves uninsured. That’s more than the 7.5 million children currently
without coverage. If CHIP isn’t
funded, between 6 and 6.6 million children could end up uninsured under the
ACA, far more than if Congress extends CHIP funding beyond fiscal year 2015.
Since we hate to end on a down note, let’s go back to the
opening message. We now have some
great new estimates of what the ACA could mean for kids, and it is very
positive news. As always, we’ll need to be vigilant, but if we can continue to
keep Medicaid and ChIP strong, we’ll be able to build on the nation’s already
substantial success in covering children and make sure that the ACA takes us
into a whole new range where 19 out of every 20 children in this country will
have coverage. We won’t stop there
because even one out of 20 children lacking coverage is too many, but it will
be a fantastic step forward.