Policy Priorities

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Real Child Health Reform for Young Children

November 2009

There are more than 8 million uninsured children in America; 2.2 million are under age 6.

In America today:

  • 2,060 babies are born each day without health coverage.
  • A baby is born at low birthweight every 90 seconds.
  • One out of every 8 babies is born preterm.
  • 78 infants die before their first birthday every day.
  • One in four two year olds is not fully immunized.
  • One out of 11 children under age 6 is uninsured.

As Congress debates the costs and benefits of health reform, one of the greatest priorities must be to ensure that our nation’s youngest children are able to access health coverage that is affordable, comprehensive, and accessible. To ensure that children are better off—not worse off— a final health reform bill must: 

  • End the bureaucratic barriers in Medicaid and CHIP that now keep 2 out of 3 of the more than 8 million uninsured children who are already eligible from actually getting the coverage they need. Older Americans are automatically covered by Medicare.  Children also need a simple, seamless enrollment process to assure they can get health coverage and keep it.
  • Guarantee every child access to the full range of health and mental health benefits they need including preventive and specialized services now provided to all children in Medicaid but to only some children in CHIP. All children’s lives are of equal value.
  • Ensure children affordable coverage by eliminating the unjust lottery of geography and providing an affordable national health safety net for children in all states with a family income below 300 percent of the federal poverty level ($66,000 for a family of four). Twenty-two states and the District of Columbia have already reached this goal of covering children up to 300 percent of poverty; two exceed this goal. No child should have to pay more for less coverage after health reform.

The House health reform bill would leave millions of children worse off by eliminating the Children’s Health Insurance Program (CHIP) and moving million of children from CHIP into a new, untested, and more expensive health insurance exchange where parents would have to pay more for their children to get fewer benefits. The Senate bill keeps CHIP until 2019 and would ensure children are protected until better or comparable benefits and cost sharing protections are in place.  President Obama has repeatedly spoken about building on what works. We can build on CHIP so that all children will be better off after health reform.


Are there pending health reform proposals that would help our youngest children? Yes.

  • Millions of young children and their parents would be eligible for Medicaid for the first time. Both the House and Senate Leadership bills expand eligibility for Medicaid, the public health insurance program for low-income children and adults. Children eligible for Medicaid will have access to all medically necessary care and cost sharing protections.
  • New insurance reforms would prevent young children from being denied needed health care. Both the House and Senate bills would prohibit group health plans or insurers offering individual or group coverage from imposing pre-existing condition exclusions and lifetime limits on health coverage, which now prevent young children from getting and keeping the care they need.
  • Preventive care for young children would be expanded. In the House bill, providers offering preventive services and other primary care services would be eligible for higher reimbursement rates, making such care more accessible.  Both the House and Senate Leadership bills exempt preventive services from cost-sharing, but the Senate bill goes further and requires that all young children receive the array of benefits included in Bright Futures – a strong benefit package recommended by the American Academy of Pediatrics. 
  • New resources for home visitation would promote the healthy development of young children.  Both bills would establish state grant programs to support evidence-based voluntary home visitation programs for pregnant women and families with young children.  The House bill also clarifies how Medicaid funds can be used for nurse home visitation programs for children under age two or first time pregnant women.

Read more about how children are faring in health reform in our legislative update and CDF's Health Coverage for All Children Campaign.