Wherry Laura R, Kenney Genevieve M, Sommers Benjamin D
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, Calif.
Health Policy Center, Urban Institute, Washington, DC.
Acad Pediatr. 2016 Apr;16(3 Suppl):S98-S104. doi: 10.1016/j.acap.2015.12.011.
Over the past 30 years, there have been major expansions in public health insurance for low-income children in the United States through Medicaid, the Children's Health Insurance Program (CHIP), and other state-based efforts. In addition, many low-income parents have gained Medicaid coverage since 2014 under the Affordable Care Act. Most of the research to date on health insurance coverage among low-income populations has focused on its effect on health care utilization and health outcomes, with much less attention to the financial protection it offers families. We review a growing body of evidence that public health insurance provides important financial benefits to low-income families. Expansions in public health insurance for low-income children and adults are associated with reduced out of pocket medical spending, increased financial stability, and improved material well-being for families. We also review the potential poverty-reducing effects of public health insurance coverage. When out of pocket medical expenses are taken into account in defining the poverty rate, Medicaid plays a significant role in decreasing poverty for many children and families. In addition, public health insurance programs connect families to other social supports such as food assistance programs that also help reduce poverty. We conclude by reviewing emerging evidence that access to public health insurance in childhood has long-term effects for health and economic outcomes in adulthood. Exposure to Medicaid and CHIP during childhood has been linked to decreased mortality and fewer chronic health conditions, better educational attainment, and less reliance on government support later in life. In sum, the nation's public health insurance programs have many important short- and long-term poverty-reducing benefits for low-income families with children.
在过去30年里，美国通过医疗补助计划、儿童健康保险计划（CHIP）以及其他州级举措，大幅扩大了针对低收入儿童的公共医疗保险覆盖范围。此外，自2014年以来，许多低收入父母根据《平价医疗法案》获得了医疗补助计划的覆盖。迄今为止，大多数关于低收入人群医疗保险覆盖情况的研究都集中在其对医疗保健利用和健康结果的影响上，而对其为家庭提供的经济保障关注较少。我们回顾了越来越多的证据，表明公共医疗保险为低收入家庭带来了重要的经济利益。扩大针对低收入儿童和成年人的公共医疗保险与减少自付医疗费用、增强经济稳定性以及改善家庭物质生活水平相关。我们还回顾了公共医疗保险覆盖可能产生的减贫效果。在确定贫困率时考虑自付医疗费用，医疗补助计划对许多儿童和家庭减少贫困起着重要作用。此外，公共医疗保险计划将家庭与其他社会支持联系起来，如食品援助计划，这些也有助于减少贫困。我们通过回顾新出现的证据来总结，即儿童时期获得公共医疗保险对成年后的健康和经济状况有长期影响。儿童时期享受医疗补助计划和儿童健康保险计划与降低死亡率、减少慢性健康问题、更好的教育成就以及成年后减少对政府支持的依赖有关。总之，国家的公共医疗保险计划为有孩子的低收入家庭带来了许多重要的短期和长期减贫益处。
