Protecting child health now and in the future

The nation has been gripped by two numbers weekly: the number of COVID-19 cases, a measure of American’s health; and the unemployment rate, a critical marker of our country’s economic health. 

At the end of 2020, COVID-19 infections are surging past the rates of many of our international peers and registering at 12 million cumulative cases and over 260,000 deaths nationally. 

At the same time, the unemployment rate is 11.1 million, or nearly 7 percent, per the National Labor Bureau of Statistics, compared with 5.8 million in February 2020. 

Although unemployment is down from the peak at 23.1 million in April, economic experts are wary as more Americans will likely report job loss this winter and the Pandemic Emergency Unemployment Compensation and Extended Benefits is imminently expiring, if Congress does not act.

Over the last 10 years, I have cared for children in a pediatric primary care clinic that predominantly serves families that depend on Medicaid coverage to sustain their access to health care. 

As I look to the next months, I am concerned as a pediatrician and health policy researcher. The uncertain future of people’s recovery from unemployment, coupled with the COVID-19 toll on physical and mental health, will mean increased reliance on our public insurance infrastructure.

Since insurance is based on individual income criteria, states have historically set the eligibility for adults far below the level at which children qualify for Medicaid and the federal poverty level. 

Commonly, parents will not have health insurance while their children do. However, children are embedded into families. In a research review, a 2002 report by the Institute of Medicine found that if a parent is uninsured, even if the children are, the children in the family may be far less likely to get the medical care they need. 

For the health of American children, Congress must continue to robustly support the Medicaid program, and the Affordable Care Act’s (ACA) provisions to expand Medicaid eligibility to at least 133 percent of the federal poverty level. 

Both are not only evidence-based health policy but also sound economic policy.  

For example, a 2017 study in Pediatrics found that expanding Medicaid eligibility to cover more low-income adults, many of whom are parents, is associated with positive “spillover” effects for their children. These children were more likely to receive recommended preventive care through well child visits.

The benefits of Medicaid coverage in childhood can also persist to adulthood with a 2018 economic study suggesting that Black adults, with Medicaid as children, had less hospitalizations and emergency department visits in adulthood. 

Medicaid can not only protect child health now but also fortify against harms to their health in the future.

Using administrative data from the IRS, a National Bureau of Economic Research study found that children from states where their eligibility for Medicaid increased, paid more taxes by 28 years old and that low-income pregnant women covered by Medicaid also had higher cumulative wages. 

Contrary to some Medicaid opposers’ arguments, Medicaid can reduce poverty and improve financial stability. 

To be sure, Medicaid and the ACA are not perfect programs and policies. 

Concerns remain about many states’ low Medicaid reimbursement for services, and the delays in reimbursement and high administrative burden are barriers for physicians to accept Medicaid-covered patients. 

But Medicaid is an evolving program with wide flexibility that allows waivers from the federal government to tailor its program in unique ways to the states’ needs and address these barriers.   

As policymakers and health leaders plan for a reality post-COVID-19 pandemic, Medicaid will be a critical safety net for my patients and families. 

Medicaid is an important building block for protecting child and adolescent health and the health of subsequent generations of Americans.

Kristin Kan, MD, MPH, MSc, is a pediatrician, researcher and assistant professor of pediatrics at Ann and Robert H. Lurie Children’s Hospital of Chicago and Northwestern University, and a Public Voices fellow with The OpEd Project.