Center for Health and Wellbeing, Princeton University (J Currie), Princeton, NJ.
Department of Medical Social Sciences, Buehler Center for Health Policy & Economics, Feinberg School of Medicine, Northwestern University (A Chorniy), Chicago, Ill.
Acad Pediatr. 2021 Nov-Dec;21(8S):S146-S153. doi: 10.1016/j.acap.2021.01.009.
Over the past 20 years, the United States greatly expanded eligibility for public health insurance under the Medicaid and Child Health Insurance Program programs. This expansion improved children's access to health care and their health, ultimately lowering preventable hospitalizations, chronic conditions, and mortality rates in the most vulnerable children at a cost that is 4 times lower than the average per capita cost for the elderly. They also had broader antipoverty effects, increasing economic security, children's educational attainments, and their eventual employment and earnings opportunities. However, in recent years, this progress has been rolled back in many states. Remarkably, although income eligibility cutoffs have remained largely constant, states have reduced child coverage through a number of administrative measures ranging from increased paperwork, to reduced outreach, new parental work requirements, changes to public charge rules for immigrants, and waivers of federal requirements to provide retroactive coverage to new applicants. The number of uninsured children was rising for the first time in decades even prior to the pandemic. With rising numbers who have lost their jobs in the pandemic-induced recession, it is more important than ever to defend and restore and improve access to public health insurance for our children.
在过去的 20 年里，美国大大扩大了医疗补助和儿童健康保险计划的公共医疗保险资格。这一扩张改善了儿童获得医疗保健的机会和他们的健康状况，最终降低了最脆弱儿童的可预防住院率、慢性病率和死亡率，成本仅为老年人人均成本的四分之一。它们还产生了更广泛的扶贫效果，提高了儿童的经济安全性、教育程度以及他们最终的就业和收入机会。然而，近年来，这一进展在许多州都被逆转了。值得注意的是，尽管收入资格截止点基本保持不变，但各州通过多种行政措施降低了儿童的覆盖范围，这些措施包括增加文书工作、减少外展、新的父母工作要求、改变移民的公共收费规则以及豁免提供追溯性覆盖的联邦要求给新申请人。即使在大流行之前，几十年以来，没有保险的儿童数量也首次出现上升。随着在大流行引发的经济衰退中失业人数的增加，为我们的孩子捍卫、恢复和改善获得公共医疗保险的机会比以往任何时候都更加重要。
