Health insurance for children and families

As nurses who desire to advocate for the health of children, it is vital that we recognize the importance that access to the healthcare system has on the ability to promote and enhance the health and well-being of children. Because our healthcare system and how individuals access that system is complicated and is currently undergoing reformation, it is necessary for nurses to help parents understand how to utilize the existing system while preparing them for the changes that are occurring through healthcare reform under the Affordable Care Act.

Private Insurance

While many of the access and insurance issues are related to low-income families, consideration should also be given to the 60%-75% of children in the United States who are covered through a private, employer-provided insurance plan (“America’s Children in Brief,” 2018). In general, private insurance provides a certain level of security for the family and guarantees access to the healthcare system, but insurance plans can be complicated. For example, payment of claims can be a challenge, especially for hospitalization and for those with a chronic illness.

As nurses, we can advocate for the family by encouraging them to know their insurance benefits and rights and how the claims process works for their specific plans. Nurses must understand this information to be a trustworthy resource and effectively advocate for the pediatric population.

Medicaid/CHIP

For those children who are not covered by private insurance and whose parent(s) meet income requirements, multiple state and federal options are offered under the Medicaid/CHIP programs (“Children’s Health Insurance Resources,” 2019). These options vary based on the state that the family resides in, so reviewing your state’s Medicaid/CHIP program website would be an excellent start to understanding how the various state plans have been developed. Also, The Henry J. Kaiser Family Foundation does valuable work in all aspects of health policy and research, and their website gives an excellent overview of how these two programs impact healthcare options and accessibility.

Affordable Care Act

In March of 2010, President Barack Obama signed into law the healthcare bill known as the Affordable Care Act (ACA), setting into motion a series of laws that changed how individuals and families obtain and use insurance coverage. From a nursing and healthcare perspective, current and future changes in healthcare must be understood to maintain our credibility as child and family advisors and advocates. Also, knowledge of these changes is necessary to identify potential new areas in which advocacy will be needed.  

Impact of ACA (“America’s Children in Brief,” 2018)

  • The percentage of children chronically uninsured declined from 5 percent in 2005–2006 to 2 percent in 2015–2016.
  • The percentage of children uninsured for up to 12 months declined from 7 percent in 2009-2010 to 5 percent in 2015-2016.
  • The percentage of children insured continuously for the past 12 months was stable from 2005-2008, then increased from 88 percent in 2009–2010 to 93 percent in 2015–2016.

A goal of the Society of Pediatric Nurses Healthcare Policy and Advocacy Committee is to provide essential tools that can be utilized to advocate for the patient populations that we all serve.  We hope the information provided here will be the beginning of additional research and action related to health insurance advocacy for children.

Additional resources:

CHIP Resources via Healthcare Marketplace 
https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/

Georgetown University Center for Children and Families
https://ccf.georgetown.edu/

Insure Kids Now
www.insurekidsnow.gov

Kaiser Family Foundation
http://healthreform.kff.org

National Academy for State Health Policy
https://nashp.org/childrens-health-insurance-resources/

References

Federal Interagency Forum on Child and Family Statistics. (2018). America’s Children in Brief: Key National Indicators of Well-Being, 2018. Washington, DC: U.S. Government Printing Office. Retrieved June 1st, 2019 from https://www.childstats.gov/americaschildren/insurance.asp

National Academy of State Health Policy. (2019). Children’s Health Insurance Resources. Washington, DC. Retrieved June 1st, 2019 from https://nashp.org/childrens-health-insurance-resources/