Health Insurance

Health Insurance


High-quality health insurance coverage allows children to regularly access comprehensive and affordable preventive services and treatment.

Data Highlights

Approximately 572,000 of the more than 738,000 uninsured children in California are eligible for public coverage but not enrolled. Of California’s uninsured children, 69% are Latino, 17% are White, 8% are Asian, 3% are African American, and 3% are of other or mixed ethnicities.

Uninsured children are:

Because health is a fundamental component of children’s overall well-being, poor health negatively impacts all areas of children’s development. For example, children who lack health coverage generally perform worse in school.

Insuring all children makes fiscal sense. Children accounted for 40% of Medi-Cal (California’s Medicaid program) enrollment in 2010, but only 18% of its expenditures. While providing children with comprehensive health coverage, including preventive care, through Medi-Cal is relatively inexpensive, the potential savings are significant since, for example, each preventable child hospitalization cost the state an estimated $7,000.

Figure: Public vs. employer-based insurance
(click to enlarge image)

Pro-Kid Policy Agenda

California should provide every child with affordable and comprehensive health insurance coverage. Specifically, the state should focus on maximizing the number of eligible children enrolled in state health insurance programs by streamlining eligibility and enrollment systems, making it easier for children to get and stay covered and supporting efforts to educate families about new coverage opportunities provided by federal health care reform and enroll children in them. Furthermore, the state needs to prioritize the funding of public health insurance programs to ensure adequate provider networks and timely access to services, so children can actually get the care these programs are intended to deliver.

Figure: California’s uninsured children
(click to enlarge image)

Momentum

Federal health care reform significantly expands health insurance coverage opportunities for California’s children. For example, children with pre-existing conditions cannot be denied coverage, health plans cannot charge co-pays for preventive health care visits, young adults can stay on their parents’ plans until age 26 and youth who are aging out of the foster care system will be eligible for continued Medi-Cal coverage. Furthermore, through the Covered California exchange, families will be better able to compare health insurance plans and choose the plan that is best for them.

In 2014, roughly half of the state’s children will be enrolled in Medi-Cal. The Medi-Cal system is foundational to the state’s implementation of federal health care reform, which expands coverage for children, youth and families. Due to a state budget decision, all 875,000 children who had Healthy Families health insurance were transitioned to Medi-Cal coverage during 2013. This influx of large numbers of children into Medi-Cal has highlighted concerns around continuity of care and the adequacy of the program’s doctor, dentist and specialist networks.