Tag Archives: Medicaid

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.

Policy Prescriptions to Prevent Teen Pregnancy

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Most teens would probably say they don’t want to become pregnant–in fact 87% of teen pregnancies in 2001 were reportedly unintended (see Figure 1). Even though there have been tens of thousands of teen pregnancies in recent years, teen births in the US have actually declined over the last 20 years, from 61.8 live births per 1,000 females aged 15-19 years in 1991 to 29.4 in 2012. This trend, which is due to factors that include teens making more informed decisions regarding their sexual health, is encouraging and suggests we can continue to make progress in preventing teen pregnancies.

First, we need to understand what makes teens more likely to get pregnant. Isabel Sawhill, Adam Thomas, and Emily Monea, in the Future of Children, outline several plausible explanations including cultural norms of increased acceptance of premarital sex and having children outside of marriage, a lack of positive alternatives to single motherhood, an attitude of fatalism, the high cost and limited availability of contraception, lack of knowledge about contraception and reproductive health, and inconsistent or incorrect use of contraception. The authors point out that these explanations generally fall into the categories of motivation, knowledge, and access.

Next, we can examine possible solutions. The Centers for Disease Control and Prevention recently released a Vital Signs brief outlining what the federal government, health care professionals, parents/caregivers, and teens can do to prevent teen pregnancy. What I like about the CDC’s suggestions is that they start where the teen is and show how adults can support teens’ healthy development. For example, professionals can encourage teens to delay sexual activity but should also encourage sexually active teens to consider the most effective methods of birth control. Parents can know where their teens are and what they are doing (isn’t there an app for that?), especially after school, and talk with their teens about sex.

Finally, are programs that promote these types of solutions worth the cost? Sawhill and colleagues, in their Future of Children article, conducted simulations of the costs and effects of policy initiatives that encouraged men to use condoms (motivation), discouraged teen sexual activity and educated participants about proper contraceptive use (knowledge), and expanding access to Medicaid-subsidized contraception (access). All three had good benefit-cost ratios, suggesting they are excellent social investments that can actually save taxpayer dollars. For more information on how to prevent teen pregnancy and unintended pregnancies in general, see the Fragile Families volume of Future of Children.

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.