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Key Issues in Children's Health Coverage

February 15, 2017

This brief reviews children's coverage today and examines what is at stake for children's coverage in upcoming debates around funding for the Children's Health Insurance Program (CHIP), repeal and replacement of the Affordable Care Act (ACA), and restructuring of Medicaid financing to a block grant or per capita cap. Following decades of steady progress, largely driven by expansions in Medicaid and CHIP, the children's uninsured rate has reached an all-time low of 5%. Medicaid and CHIP are key sources of coverage for our nation's children, covering nearly four in ten (39%) children overall and over four in ten (44%) children with special health care needs. Medicaid serves as the base of coverage for the nation's low-income children and covered 36.8 million children in fiscal year 2015. CHIP, which had 8.4 million children enrolled in fiscal year 2015, complements Medicaid by covering uninsured children above Medicaid eligibility limits.There is much at stake for children's coverage in upcoming debates. New legislative authority is needed to continue CHIP funding beyond September 30, 2017. In addition, the Administration and Republican leaders in Congress have called for repeal and replacement of the ACA and restructuring of Medicaid financing to a block grant or per capita cap. Loss of CHIP funding, repeal of the ACA, and capping Medicaid financing all have the potential to reverse the coverage gains achieved to date and increase the number of uninsured children. In addition, rollbacks in coverage for parents could contribute to coverage losses among children and increased financial instability among families.Reductions in children's coverage would lead to reduced access to care and other long-term effects for children and increase financial pressure on states and providers. Reductions in children's coverage would result in fewer children accessing neededcare, including preventive services such as well child visits and immunizations. Research also suggests that reductions in children's coverage could have broader long-term negative effects on their health, education, and financial success as adults. In addition, loss of CHIP funding and reductions in federal Medicaid financing would create funding gaps that would increase financial pressure on states and providers.

Cost and Access Challenges: A Comparison of Experiences Between Uninsured and Privately Insured Adults Aged 55 to 64 With Seniors on Medicare

June 4, 2012

Examines trends in the prevalence of unmet medical needs or delayed care due to cost and problems paying medical bills or buying prescription drugs among uninsured and privately insured 55- to 64-year-olds compared with among Medicare beneficiaries.

Emerging Medicaid Accountable Care Organizations: The Role of Managed Care

May 29, 2012

Examines the Medicaid payment and care delivery systems in states working to develop accountable care organizations within Medicaid, how ACOs may be structured to fit into them, and how Medicaid ACOs differ from those in Medicare and the private market.

Massachusetts Health Care Reform: Six Years Later

May 21, 2012

Examines Massachusetts' implementation of healthcare reform since 2006 and outcomes to date, including expansion of coverage, gains in access to care, ongoing issues with rising costs, and changes needed to comply with federal healthcare reform.

How Is the Affordable Care Act Leading to Changes in Medicaid Today? State Adoption of Five New Options

May 18, 2012

Examines state takeup of five Medicaid options under federal healthcare reform, including early expansion of coverage, funding to upgrade eligibility systems and disease prevention, health homes for the chronically ill, and integration of dual eligibles.

Health Care Costs: A Primer 2012: Key Information on Health Care Costs and Their Impact

May 9, 2012

Examines changes in U.S. healthcare spending, compared with other countries and per capita; what it pays for; who pays; and how healthcare costs affect families and employers. Examines why healthcare costs outpace economic growth and how to slow growth.

Enrollment-Driven Expenditure Growth: Medicaid Spending During the Economic Downturn, FFY2007-2010

May 4, 2012

Examines Medicaid spending growth by category and per enrollee, and the role of and factors behind enrollment growth, including the recession, federal protections against eligibility restrictions, additional funding, and expanded eligibility.

Insurer Rebates Under the Medical Loss Ratio: 2012 Estimates

April 25, 2012

Estimates 2012 rebates to be paid to policy holders by insurers failing to meet federal healthcare reform's requirement that they spend a minimum ratio of 80 to 85 percent of premiums on medical care expenses. Examines data by state and market segment.

The Diversity of Dual Eligible Beneficiaries: An Examination of Services and Spending for People Eligible for Both Medicaid and Medicare

April 18, 2012

Analyzes updated data on the characteristics, health status, healthcare utilization, and spending for those eligible for both Medicaid and Medicare compared with those of non-dual eligible Medicare beneficiaries and implications of their diversity.

Massachusetts' Proposed Demonstration to Integrate Care for Dual Eligibles

April 18, 2012

Outlines the current service delivery model for those eligible for both Medicaid and Medicare, key design elements of the proposed integrated care organizations, revisions made in response to stakeholder comments, and considerations for evaluation.

Key Issues in Understanding the Economic and Health Security of Current and Future Generations of Seniors

April 10, 2012

Examines key issues seniors face in ensuring economic and health security and the role that Medicare, Medicaid, and Social Security play in ensuring seniors' financial security, including concerns about medical debt and disparities by race/ethnicity.

How Does the Benefit Value of Medicare Compare to the Benefit Value of Typical Large Employer Plans?: A 2012 Update

April 4, 2012

Compares the value of benefits for those age 65 and older under Medicare and under two large employer plans typical of those for which premium support could be offered under reform proposals. Examines share of costs paid by the plan and by individuals.