The Complex Modern Family and Barriers to Children’s Health Coverage – Say Ahhh! A Children’s Health Policy Blog

Thumbnail image for Thumbnail image for Gene Lewitt.jpg

By Gene Lewit, The David and Lucile Packard Foundation

Children with health insurance coverage start off life on
the right foot: they are healthier, miss fewer days of school and their parents
and guardians miss less work. Happily, recent efforts to
grow and strengthen Medicaid and the Children’s Health Insurance Program have
extended coverage to more children than
ever before. Part of the excitement generated by the Patient Protection and
Affordable  Care Act (ACA) is that
it promises to reduce the number of uninsured children even
further and extends coverage to parents so that children can be covered in the
context of their families which will strengthen families and holds the promise
of simplified administration and improved health outcomes. But as a recent
front page article in
the New York Times observed, we live in a very different America “from the
1950s when the TV characters Ozzie and Harriet were a national archetype”.

A new Packard Foundation-funded Research Brief from the
Urban InstituteAddressing Barriers to Health
Insurance Coverage Among Children: New Estimates for the Nation, California,
New York, and Texas
, raises concerns about the challenges some children may face in obtaining health
insurance coverage as a result of the complexity of modern family situations
and the way in which child and family coverage options are structured. For
example, complex coverage scenarios (potential mismatches between family
characteristics and program characteristics) arise when children are eligible
for Medicaid or CHIP but their parents are not, or when children live in
households with at least one absent parent (single parent households,
grandparent or other kinship care arrangements, etc.).  

Top line findings include:

  • More than half of American children may face at least
    one complex coverage scenario under the ACA.
  • An estimated 18.7 million children will be eligible for
    Medicaid or CHIP but their parents will not be eligible for such coverage.
  • An even larger group of children, 27.7 million, live in
    households with at least one absent parent.
  • Children facing at least one complex coverage scenario
    are currently much more likely to be uninsured than other children and account
    for 62 percent of all currently uninsured children.
  • The uninsured rate for children not in a complex
    coverage scenario is 7.1 percent vs. a rate of 11.7 percent for children with
    at least one absent parent.
  • 76 percent of Medicaid/CHIP eligible uninsured children
    are in complex coverage scenarios.

More detailed data are presented in the brief. Since
states will lead the implementation of the ACA, the brief also presents
estimates for California, New York, and Texas, states with large juvenile
populations but different rates of uninsured children and health policy

Because so many children will find themselves in these
complex scenarios, it is important to implement regulations, policies,
programs, and strategies which explicitly address some of the potential
barriers to coverage in order to maximize the benefits of the ACA for children.
Families will need to be educated about the changes well in advance and
oriented to their new coverage options. States have important roles to play and
should use data and input from parents, outreach and enrollment providers and
others involved to determine the best way to address these issues in their

Even though there is some uncertainty over the future of
the ACA, the data in this new brief highlight that now is the time to pay
attention to these issues. A large proportion of currently eligible but
uninsured children are facing these complex coverage scenarios.  As a result, policymakers can feel
confident that the payoff to a focus on these children will be immediate and
lasting regardless of the resolution of current uncertainties over ACA

Most American children face at least one complex coverage
scenario, which means we have to design coverage programs with this norm in
mind. ACA implementation provides the perfect opportunity for public policy and
practice to reflect the new norm when it comes to covering children and their

Scroll to Top