Covering All Kids: A Vision for the Future

Elementary school boy at the front of the school bus queue

Once a source of national pride and a testament to the power of bipartisan cooperation, our children’s health coverage has now eroded – the number of uninsured children is going up after years of decline. It is time for policymakers at the state and federal level of both parties to rededicate themselves to covering all children. Today we release the ninth in our series of reports on the Future of Children’s Health Coverage, this paper provides a menu of ideas to regain the momentum to Cover All Children.

We believe that all children in the United States, regardless of where they live or their immigration status, should have health insurance – not only because it is the right thing to do – but because it is the smart thing to do – to ensure that our country thrives by investing in our future. Having health insurance is essential to a child’s healthy development and is correlated with better educational outcomes, higher paying jobs as an adult, and improved health over the lifetime.

It goes without saying that our focus on children in this paper does not diminish the importance of covering their parents and caregivers. Children need healthy parents, caregivers, and communities to grow and thrive, which is why we believe adult coverage should be viewed as a children’s issue as well. Covering parents and caregivers helps children get the care they need and improves the financial stability of the whole family.

Our objective in starting the Future of Children’s Health Coverage series was to generate ideas and suggestions for policy change targeted at children – a role that we take seriously as a key part of our mission at the Georgetown University Center for Children and Families. Health policy change does not come easily in the United States, and the current polarization and bitter attacks around the Affordable Care Act have only made it harder for bipartisan efforts to succeed. In the past, children have offered a path to lower the temperature and move forward toward common ground.

We anticipate this paper will raise questions, but it is our hope that it will also stimulate discussion, action, and more thinking. For example, we do not answer the question of how to pay for many of the policies recommended here and the complexities of Medicaid/CHIP matching rates – which would involve possibly unacceptable tradeoffs. Nor do we answer the question of how to reach universal coverage for everyone or improve coverage for individuals with high needs and high costs. But, we believe that children are an essential piece of the puzzle to America’s future. Just as adults who turn 65 know that Medicare is there for them, our paper offers a blueprint for a national continuum of care for children.

We believe it is time to shift to a new, national expectation that no baby leaves the hospital without health insurance. Our suggestion is that these infants be auto enrolled in Medicaid if their parent indicates that they don’t have private insurance to enroll their child in. From there, states could offer continuous coverage for a period of five years, and coverage status would be checked every year as part of school enrollment.

National continuum of health coverage

Our paper has other ideas too – that range from state options that exist today such as adopting 12-month continuous eligibility and covering lawfully residing immigrant children without the 5-year bar to improving outreach and enrollment efforts to increase coverage rates among groups with higher rates of uninsurance. We hope that you will read it and share it with partners and elected officials. When we analyze the new Census data this fall on the number of uninsured children, we do not believe we will see significant improvement and, in fact, the situation may get worse. Policymakers should not wait for more bad news before rolling up their sleeves and getting back on track for children’s health.

Health coverage is the key that opens the door to a child’s life long success. Policymakers must renew their efforts to regain momentum on children’s coverage and strive to reach all children. This policy brief offers one way forward.