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JAMA Pediatrics Viewpoint: Medicaid expansion healthy for children and parents


INDIANAPOLIS — Children with parents who also have health coverage are more likely to have better care than children with uninsured parents, according to an opinion piece in the current issue of JAMA Pediatrics.

Aaron E. Carroll, M.D., M.S., associate professor of pediatrics and director of the Center for Health Policy and Professionalism Research at the Indiana University School of Medicine, and Austin B. Frakt, Ph.D., of the Boston University schools of medicine and public health, are the authors of the Viewpoint “Medicaid Expansion: Good for Children, Their Parents, and Clinicians.”

“Public insurance makes a real difference in the health of children. Those who are covered are significantly more likely to have a usual source of care than those who are uninsured, which is strongly associated with better outcomes,” Carroll and Frakt wrote.

The authors say that the State Children’s Health Insurance Program has reduced the number of uninsured children from 16 percent in 1996, the year before SCHIP was adopted, to 9.4 percent in 2011. More than one-third of children in the United States are covered by Medicaid and SCHIP. Parents, on the other hand, are not so fortunate.

“This is important, because the insurance status of a parent can significantly impact the health of his or her child,” they wrote. “Children with uninsured parents are significantly less likely to receive recommended health services even if they themselves are covered.

“The Affordable Care Act changes Medicaid into a universal program for all people, children and adults alike, in families with incomes below 138 percent of the federal poverty line.”

The authors argue that states refusing to expand Medicaid coverage to those who would qualify under the new income guidelines may find that their fears of not being able to afford the expansion are mostly unfounded. The federal government will pay 100 percent of the cost until 2017.

A recent study published in the Journal of Health Politics Policy Law shows that the Medicaid expansion would account for less than 1 percent of a state’s gross state product. A disproportionate share of medical care will fall on hospitals in states that do not expand Medicaid coverage, the authors argue.

“Although a debate might continue in the political sphere, the evidence is quite clear that expansion of the program has many benefits for states and their low-income residents.”