Losing Ground: Current Medicaid Policy Threatens Children's Access to Health Care

Abstract

From 2008 through 2016, the number of uninsured children in the United States decreased from 7.6 million to 3.6 million ( Alker and Roygardner, 2019 Alker J. Roygardner L. The number of uninsured children is on the rise. 2019 Google Scholar ). However, since 2017 that trend has reversed. Over 4 million children are now uninsured—the highest rate of uninsured children since the implementation of the Affordable Care Act (ACA)—and over one-quarter of these children are aged under 6 years ( Burak et al., 2019 Burak E.W. Clark M. Roygardner L. Nation's youngest children lose health coverage at an alarming rate. 2019 Google Scholar ). According to the periodicity schedule for preventive pediatric health care, children should have 30 well-child visits from birth through 21 years of age, with 15 of these visits occurring from the first weeks of life through 6 years of age ( Hagan et al., 2017 Hagan J.F. Shaw J.S. Duncan P.M. Bright futures: Guidelines for health supervision of infants, children and adolescents. fourth ed. American Academy of Pediatrics, Elk Grove Village, IL2017 Google Scholar ). These visits provide preventive care, including developmental assessment, screening, and immunizations, offer anticipatory guidance to parents, and promote trusting relationships with health care providers. When children lack health insurance coverage, they often go without preventive services and experience suboptimal health outcomes ( Flores et al., 2017 Flores G. Lin H. Walker C. Lee M. Currie J.M. Allgeyer R. Massey K. The health and healthcare impact of providing insurance coverage to uninsured children: A prospective observational study. BMC Public Health. 2017; 17: 553 Crossref PubMed Scopus (10) Google Scholar ). Eileen K. Fry-Bowers, Associate Professor, University of San Diego, Hahn School of Nursing and Health Science, San Diego