Awakening the Force of Two-Generations’ (Children and their Parents) Coverage, Access and Affordability: Historic Gains Worth Celebrating in 2016

wong_liane_packardBy Liane Wong, Dr.P.H. The David and Lucile Packard Foundation

While there’s been an incredible amount of buzz around the release of “Star Wars: The Force Awakens” this December, a less heralded moment in history was made at the end of 2015. But it’s history worth celebrating for our nation’s families and children, and one we should share around the dinner table in the coming months. Many of us can recall what it was like pre-2010 when having a pre-existing condition or being a young or new parent would often offer no or few affordable health insurance coverage options for families. The Patient Protection and Affordable Care Act (ACA) was enacted in 2010 and has since reshaped the U.S. coverage and healthcare landscape.

Last fall, as we marked the first year of ACA implementation, researchers at the Urban Institute released early estimates from the Health Reform Monitoring Survey (HRMS) that has tracked coverage among nonelderly adults (ages 18-64) since the beginning of 2013. These estimates from September 2013 to March 2015 highlighted the uninsured rate of parents dropping by 36 percent, with the largest gains among those with incomes reached through the ACA’s expansion of Medicaid. Prior to Urban conducting these special analyses, the uninsured rate for U.S. parents had not been readily available from other sources although overall adult uninsured rates were notably higher prior to the law’s implementation.

A new policy brief released this week provides updated estimates of changes in coverage for parents and children, as well as changes in their health care access, affordability, and satisfaction with health plans. The new HRMS data show a substantial increase in coverage among parents between 2013 and 2015. This change for parents has a range of positive implications for their own health, the health of other members in their family including their children, their parenting practices and families’ overall economic security.

These connections are not speculative, as numerous studies and the wisdom of practice over the past decades have shown that the coverage and health of parents is inextricably linked to the health of their children and their family’s stability. The problems of uninsurance and unaffordable health care have not yet been solved: according to other new HRMS data, most uninsured parents cite cost or affordability as a reason for lacking coverage and most report facing serious financial hardship, which may prevent them for enrolling in a health plan. Yet coverage gains under the ACA offers real hope that more families can now pursue their hopes and dreams without the fear of being unable to pay their rent or for needed child care, put food on the table, or make difficult trade-offs in service of medical bills not covered by insurance. Instead of worrying, they can be better and more present parents, more productive in their own lives and better prepared to be lifelong teachers for their kids.

In concrete terms, here’s what the Urban data reveals about family coverage and their access to needed care with the ACA:

  • Between 2013 and 2015, the share of parents with health insurance increased 6.4 percentage points and the share of children with coverage increased 1.7 percentage points – a historic high for families.
  • Relative to 2013, parents reported improved access to care in 2015, namely more likely to have a usual source of care and a routine checkup in the last year.
  • Parents were also less likely to go without care for affordability reasons or struggle to pay family medical bills. They also reported higher satisfaction with their premiums and being protected against medical bills.
  • Finally, parents had higher satisfaction with multiple aspects of their children’s health plans in 2015 as compared to just two years earlier. Parents also reported that they were more confident that their child could get health care if the child needed it.

You can find the more detailed findings here and here and some additional food for thought on the potential of Two-Generation approaches at Aspen Ascend. It’s worth noting however that more work still needs to be done under ACA implementation as there are still many families for whom affordable coverage is not yet available or who still worry about the cost of seeking care. But let’s really celebrate these force-making gains for our nation’s families and aim to build upon them over the coming decade.