While the Affordable Care Act’s Medicaid expansion was intended to help the large number of uninsured adults who couldn’t afford private insurance, the policy changes have proven to be of great help to children as well. In February 2021, we released a report on the critical link between expanding adult Medicaid and improving children’s health coverage. We found that between 2016 and 2019, the child uninsured rate jumped from 3.5% to 4.1% in states that expanded Medicaid, while the uninsured rate jumped from 6.5% to 8.1% in states that refused to expand Medicaid. We also review studies that link improvements in children’s health insurance in expansion states to parents obtaining their own insurance, protecting families from medical debt, and improving child health measures.
Further research over the past two years has provided further evidence that Medicaid expansion to adults can also help children. A 2021 study by researchers at Columbia University Mailman School of Public Health, the University of Chicago, and MIT reviewed Oregon’s 2008 Medicaid expansion. This study is particularly powerful because of a unique factor in Oregon’s 2008 expansion—adults were randomly assigned to expansion and nonexpansion groups. Looking at these groups of parents, the researchers found that compared with the non-expansion group, for every nine adults who had health insurance, one child also had health insurance. This “welcome mat” effect occurs when people who were previously Medicaid eligible (children, in this case) enroll in Medicaid as a result of new Medicaid coverage expansions to parents and other adults.
In 2022, researchers looking specifically at the impact of Medicaid expansion on health care delivery found that children had more insured visits to community health centers when their parents received Medicaid coverage: “Children with one parent receiving Medicaid were less likely to receive Insured children had 4.4% more medical visits after Medicaid than children on Medicaid.” Before the ACA. “In expansion states, kids are more likely to see a doctor. An article just published in The Lancet Child and Adolescent Health journal summarizes the findings, showing:”[E]Xpansion states have improved perinatal and maternal health, increased use of preventive care, reduced incidences of child neglect, lowered high school dropout rates, and reduced infant mortality by nearly 50 percent. “
In 2022, researchers writing in the Journal of Clinical Oncology found that survival rates for young adults with cancer were related to the Medicaid expansion status of the state in which they lived—younger adults in Medicaid expansion states lived longer long. Researchers at the University of Washington and Duke University, who conducted the study in 2023, found that Medicaid expansion was associated with improved overall survival and outcomes for children with cancer, showing the impact of broader coverage. Additionally, the Urban Institute estimated in a 2023 paper that if the remaining states that did not expand Medicaid all expanded Medicaid, the total number of uninsured children in those states would fall by 7.3% because of the impact that would occur when parents obtain coverage on their own. The “welcome mat” effect. Medicaid expansion.
Finally, the U.S. Census Bureau released a comparison of Medicaid expansion state decisions and children’s health insurance coverage based on 2021 Current Population Survey data. While the national report found a decrease in the overall rate of uninsured children, the report also found that states that did not expand Medicare had a lower share of children without health insurance compared with lower uninsured rates in states that had expanded Medicaid. Again much higher (7.1%) (4.0%).
As changes in federal and state policies affect children’s health coverage, one thing is consistent in the data over the years. Expanding Medicaid coverage for parents also benefits children, even if they are not directly eligible for the new expanded coverage available to parents and other adults. In expansion states, children continue to obtain health insurance at higher rates, see health care providers more often for necessary visits, and experience better health outcomes.