BOCYF Projects

Children, Health Insurance, and Access to Care

Publications: America's Children: Health Insurance and Access to Care (1998); Systems of Accountability: Implementing Children's Health Insurance Programs (1998)

More than 11 million American children are uninsured. Most uninsured children live in families with working parents. Many are not eligible for Medicaid because their parents tend to work in low-wage jobs for employers that do not offer health insurance, and the parents cannot afford to purchase private insurance on their own. More than 3 million children nationally are eligible for Medicaid but are not enrolled for a variety of reasons.

In this context and at the request of the Robert Wood Johnson Foundation, the Board on Children, Youth, and Families and the Division of Health Care Services of the Institute of Medicine convened the Committee on Children, Health Insurance, and Access to Care, to examine the extent of health insurance coverage for children and to analyze evidence of the relationship between health insurance coverage and children's access to health care. The committee was asked to focus on safety net providers such as community health centers and children's hospitals that traditionally have provided care for uninsured children and their families, to examine trends affecting these providers, and to evaluate the potential effects of those trends on children's access to health care. They also explored the changing role of Medicaid under managed care; state-initiated and private-sector children's health insurance programs; specific effects of insurance status on the care children receive; and the impact of chronic medical conditions and special health care needs.

The committee met four times between March 1997 and January 1998, and held a public workshop in June 1997 in Washington, DC. In addition, a liaison panel was formed with nearly 200 representatives of state and federal government, national organizations, health care providers, and other groups. Members of the liaison panel attended the workshop and also submitted written statements for the committee's consideration. The committee included 14 individuals with expertise in health care financing and delivery, private indemnity insurance, managed care, Medicaid, and other public programs; health care delivery, both primary and specialty care for children and adults; health care policy; legislative policy, regulation, health law, and health economics; health services research; and epidemiology.

The committee released two reports in June 1998. The first report, America's Children: Health Insurance and Access to Care, presents the committee's review of evidence and draws conclusions about the relationship of children's health insurance and access to care.

The second report, Systems of Accountability: Implementing Children's Health Insurance Programs, stems from the last committee meeting, which the committee held specifically to consider the new State Children's Health Insurance Program (SCHIP) enacted as part of the Balanced Budget Act of 1997. This report addresses practical concerns about the implementation and evaluation of SCHIP and presents the committee's recommendations about accountability for measuring the program's impact. The report was intended to serve as a resource to policy makers as SCHIP is implemented across the country.