Children’s Health Coverage: On the Road to 100 Percent?

By Ben Kerman, The Atlantic Philanthropies

The 2015 open enrollment period offers an opportunity to build on tremendous progress in bringing health coverage to more children and their families. An analysis of recent census data by Georgetown Center on Children and Families confirms that many states are making headway. Twenty five states achieved statistically significant decreases in uninsured rates since ACA implementation; no state had an increase.

But further progress is far from certain. Efforts to find and enroll hard to reach children and families must persist. One to two children in the average classroom still lack coverage. Nevada shows both the promise and the challenge: Nevada had the highest percentage point decline (5.3) in children’s uninsured rate of any state from 2013 to 2014. However, nearly one in ten children there still lack insurance – much higher than the national average of six percent. Advocates and funders that care deeply about universal coverage for children must redouble their efforts to advocate for coverage expansion and for resources to scale up proven outreach and enrollment strategies.

Overall, states that expanded Medicaid to low-income parents and other adults achieved better results in reducing the number of uninsured children – making about twice the progress of states that did not expand Medicaid. A recent brief by researchers at Mathematica examined how children’s advocates backed Medicaid expansion in New Mexico and adoption of a Basic Health Plan in New York. Advocates achieved policy wins first by crafting the most effective messages that would resonate with policymakers and substantiated them with well-researched studies. Then, recognizing that messaging and studies alone wouldn’t mobilize enough support to win, advocates used additional strategies of public engagement and forging broad coalitions of stakeholders to advance their agendas.

Funders can help to spread successes like these further. Atlantic Philanthropies has focused on health care access issues since before the Affordable Care Act, and has been fortunate to learn from persistent and innovative advocates how to address enrollment challenges. Atlantic’s KidsWell initiative, designed to ensure access to health insurance for all children in seven targeted states, supports champions who continue the hard work of state-based advocacy. Mathematica’s evaluation of the KidsWell campaign finds that three years into their campaigns, grantees believe KidsWell funding enhanced their advocacy skills and permitted them to build strategic partnerships that leveraged and capitalized on partners’ strengths. In all seven states, grantees reported coalition building and direct contact with elected officials as their most effective activities, while administrative advocacy, mass media, and grassroots organizing were viewed by a majority of KidsWell states as less effective.

It’s not easy to continue making progress. The success of advocacy activities depends on state context, political environment, and the policy goal. The example set by intrepid advocates at the state and local level reminds us that further progress can be made this open enrollment period, with new partners, creativity, and determination.

Ben Kerman is Head of Strategic Learning & Evaluation at The Atlantic Philanthropies.