Health Care Reform for Children with Public Coverage

How Can Policymakers Maximize Gains and Prevent Harm?

Congress is now debating legislation that might extend insurance coverage to every American. Proposals are likely to involve new subsidies for health insurance coverage, new approaches to encouraging enrollment, a mandate requiring people to obtain insurance and the creation of a health insurance exchange. Millions of children and parents stand to gain coverage under health care reform, which should improve their access to care. The effects of reform are much less clear, however, for the more than 25 million children who currently have coverage under Medicaid or the Children’s Health Insurance Program (CHIP)—children who are disproportionately likely to be poor, to belong to racial or ethnic minorities, and to have chronic health problems.

A new analysis from the Urban Institute discusses current coverage and access to care for these low-income children. The paper considers the potential risks of shifting children who currently have public coverage into plans sold in a new exchange, and explores how health care reform could be structured to address these children’s needs.

According to authors Genevieve Kenney and Stan Dorn, proposals to move children from Medicaid and CHIP into a new health insurance exchange could make these children worse off, through the potential loss of benefits and legal protections offered through public insurance. However, if reimbursement rates are higher in the exchange than paid under Medicaid and CHIP, children’s access to providers could improve.

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