Tag Archives: health care

Child Health and Health Care Access

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Many celebrated outside the Supreme Court two weeks ago following SCOTUS’s decision to allow health care subsidies through the Affordable Care Act (ACA). I was among those who breathed a sigh of relief at home after reading that our coverage through the Marketplace would be continued. Now as life returns to normal and we no longer have to worry for the time being, let’s not forget the importance of health care access, especially for children, and the fact that there are still children who don’t have it. Exactly how important is health care access? Lindsey Leininger and Helen Levy joined forces in the latest Future of Children issue to tell us about the influence access has on child health.

Research on this question has had varying results, but Leininger and Levy argue that, overall, access to care does improve child health and that the influence is often more significant for those who are marginalized. The classic RAND Health Insurance Experiment, for instance, suggested that in the population as a whole, the generosity of insurance coverage did not significantly determine overall health. However for high-risk (meaning low-income) children, generosity of coverage did affect health.

Studies on Medicaid eligibility show further evidence: in the year after implementation, mortality fell among nonwhite infants, and this effect persisted for at least 10 years. Also, among children in low-income families, those who experienced more years of Medicaid eligibility were in better health. A variety of other studies have associated expansions of Medicaid eligibility with reductions in child mortality. With regard to Medicaid enrollment, positive effects have also been seen, such as increased enrollment leading to decreases in hospital admissions for conditions that could be well-managed by primary care.

Leininger’s own research has shown that lack of coverage can be a strong detriment to child health. Her study showed that each additional month without coverage was associated with a small, statistically significant decline in the probably of a child seeing a doctor for a well-visit or any other visit. A four-month spell of being uninsured, for example, resulted in a 4 percent decrease in the likelihood of any visit and a 9 percent decrease in the likelihood of a well-visit.

So insurance coverage is good for child health, especially for marginalized children. But according to our authors, although “the ACA builds on the earlier successes of Medicaid expansion and CHIP to promote children’s access to care… challenges remain.” Access to care improves child health, but it is not the only factor. For example one study cited by Leininger and Levy estimates that lack of access to medical care explains only about 10% of early mortality in the population as a whole; less than genetics (30%), social circumstances (15%), and behavioral factors (40%). To improve children’s health overall and consider policies that may do so, we must also consider the larger picture. To learn more about other factors that influence children’s health, read the full Future of Children issue on Child Health.

A Holistic Approach to Healthcare

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The health of parents and children are closely intertwined, yet the health-care system generally does not take an integrated approach to family health treatment. For instance, pediatricians who treat children with asthmatic symptoms often do not ask about parents’ smoking and rarely intervene to help change the parents’ smoking behavior. It’s probably not considered within the scope of their practice and they aren’t able to bill the treatment to the child’s insurance. This situation is problematic since a primary cause of the symptoms is likely the secondhand smoke in the child’s environment. Pediatricians don’t necessarily need to abandon their specialization and start treating parents and children in the same practice, but the solution likely lies in reforming the health care system to be more holistic and interconnected.

Sherry Glied and Don Oellerich write in the Two-Generation issue of Future of Children that few programs aim to treat parents and children together due to structural barriers in the U.S. health-care system. They argue that the Affordable Care Act, which expands coverage to millions of lower-income parents, is a necessary step to help establish a policy environment to allow for two-generation approaches to health.

Importantly, it’s up to the states to take two further steps. First, they need to ensure that parents and children can be treated in the same programs despite Medicaid eligibility. Second, they should give providers incentives to generate meaningful changes in their practices, such as embracing the patient-centered medical home model which makes additional payments to providers who coordinate their services with other medical and social service providers.

Glied and Oellerich conclude that the rationale for two-generation programs that target both children’s and parents’ health problems is strong, and there are new opportunities ahead to develop and implement these programs.

New Census Measure Provides More Detailed View of Poverty

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The U.S. Census Bureau recently announced plans to publish a new poverty measure in conjunction with the traditional measure, a move that can shed additional light on vulnerable populations and how current policies are serving them. While the new measure will not replace the current one in policies and determining program eligibility and funding, it will reveal a more nuanced view of the experience of lower-income Americans.
The standard measure, first published in 1964 as part of Lyndon B. Johnson’s War on Poverty, calculates a federal poverty threshold based on food expenditures as determined by the “thrifty food plan” developed by the U.S. Department of Agriculture. The measure is quite simple; it presumes that food expenditures should make up a third a household’s budget, so it simply multiplies the amount allowed under the thrifty food plan by three. Families are considered poor if their household income falls below this level. While the threshold has been continually adjusted to account for inflation, it does not account for regional differences. Even more problematic is that over the past half-century food prices have dropped relative to expenses such as housing; given that housing costs have soared since the 1960’s, the current measure does not accurately capture the financial strain of some families.
The new measure is based on different calculations of necessary spending and family resources. Household spending includes the costs of food, housing, utilities, and clothing, as well as a little bit extra. Family resources include not only income, but also in-kind benefits such as food stamps. The resource measure also subtracts taxes and tax credits, work expenses such as commuting costs and childcare, and out-of-pocket medical expenses to represent the family’s actual ability to cover the expenses listed above. This more accurate and thorough measure acknowledges the complexity of resources and spending, and it allows for geographic adjustment such as greater costs in places with more expensive housing.
Scheduled to be released annually starting in fall 2011, this new measure will help policy evaluation in three major ways. First, it will help determine if all vulnerable populations are being reached. Second, by including additional measures of needs and resources, researchers and policy makers can better analyze whether assistance programs are mitigating families’ experiences of poverty, such as the difference food stamps make to a family. Third, the measure will show how much necessary expenses add to a family’s burden. By extending beyond food costs to include housing, out-of-pocket medical expenses, and utilities, policy makers can identify areas where the poor need the most help to fulfill their families’ needs.
As explored in an issue of The Future of Children that focuses on antipoverty policies, these types of governmental assistance for child care, health care, and education are critical for needy families. The Census’s new poverty measure allows a new insight into these issues and interventions and can provide a powerful new tool for analysis in the coming years.

For more details, see the federal government’s working group report from March 2010: http://www.census.gov/hhes/www/povmeas/SPM_TWGObservations.pdf

Health Care Coverage for Adults Improves Children’s Health

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A new health care bill is taking form in Congress, setting off a national conversation about what an ideal health care plan for the country should look like. Two recent volumes of The Future of Children address the importance of health care for children: “Children’s Health and Social Mobility” in Opportunity in America, and “A Health Plan to Reduce Poverty” in The Next Generation of Antipoverty Programs.
The nation’s health care concerns are not just about coverage, but also about having healthier citizens – and healthy lifestyles begin in childhood. One way to increase child health is to increase their parents’ access to healthcare—parents who are proactive about their own health are often better at getting their kids preventative care too, rather than just going to hospital emergency rooms when problems emerge. Although nearly all children in families with incomes under 200 percent of poverty are eligible for either Medicaid or the State Children’s Health Insurance Program (SCHIP), the parents of these poor and near-poor children often lack health insurance.
Parents who leave welfare normally lose coverage after one year unless their employer provides it, and many employers of low-wage workers do not offer health insurance. As a result, many of the working poor and near-poor have no coverage at all, and the idea of losing Medicaid even discourages adults from working. More available and affordable health care would both remove this disincentive from work and benefit children’s health. Beyond increasing health care coverage for parents, a government plan should also educate parents as “the primary gatekeepers for their children’s health.” Even if health care is available, parents must learn how to make the best use of preventative care and medical information.
Health issues of low-income children have major consequences for both them and society at large. These children may miss more classes or be less able to concentrate on studies, ultimately making them less likely to stay in school. Education challenges and health issues persisting into adulthood may decrease earnings and socioeconomic status. This has wider consequences, as lower-income families may require more state support while contributing fewer tax dollars. In addition, education is often seen as “the great equalizer” and the means by which the American Dream operates, so if the poor health of lower-income children limits their social mobility then America may not be living up to its full promise. These situations are problems for all of society, not just those most directly affected, so health care reform that improves child health should be universally appealing.