The Medicaid Expansion is Good for Parents AND Good for Children

Parents and children are more likely to have health coverage now than they were before the Affordable Care Act took effect. The Urban Institute released new research that shows the rate of insurance coverage for parents and children increased significantly between June/September 2013 and March 2017. During the time period, the rate of coverage increased 6.2 percentage points for parents (from 83.2 percent to 89.3 percent) and 1.9 percentage points for children (from 94.8 percent to 96.7 percent).  

As readers of Say Ahhh! know, any coverage gain for parents is also good for children. Not surprisingly, the authors find a strong link between coverage for children and parents: the rate of uninsured children with parents who are uninsured is 21.6 percent compared to only .9 percent for children of insured parents.

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Relatedly, the first national-level estimates of the welcome mat effect of the Medicaid expansion on coverage for children below 138 percent of the federal poverty level was published in Health Affairs. The authors estimate that 710,000 children gained public coverage when their parents signed up between 2013 and 2015. The effect was largest among children whose parents gained Medicaid eligibility through the expansion. For these children, coverage increased (5.7 percentage points) more than double the increase observed for children whose parents were not eligible for Medicaid (2.7 percentage points).

The fascinating chart below from the study shows how parents’ Medicaid eligibility is closely tied to children’s coverage. Children with parents eligible for Medicaid before and after the ACA had significantly higher coverage rates than children with parents who were not eligible for Medicaid. But the largest percent gain in coverage was for children with parents who were newly eligible for Medicaid (8.1 percent compared to 4.6 percent for the baseline).

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Among children whose parents were eligible for Medicaid before and after the ACA, the welcome mat effect only occurred in expansion states. There were significant coverage gains for those children in 2014 and 2015 in expansion states, but not in non-expansion states. If all states had expanded Medicaid, the authors estimate that an additional 200,000 eligible children would have gained coverage by 2015. While this was a missed opportunity to lower the number of uninsured children and parents, there may be hope that states will expand Medicaid in the future.